Dissertations / Theses on the topic 'Scapular Dyskinesis'

Scapular dyskinesis is a common occurrence in overhead athletes, i.e. athletes who participate in any sport where the upper arm and shoulder is used above the athlete’s head. However, no consensus has been reached on how to evaluate scapular dyskinesis quantitatively. In this thesis, we developed a measuring tool that can be used to evaluate certain key clinical parameters specific to scapular dyskinesis. The tool employs a 3D structured light computer vision approach to create a surface map of the soft-tissue across the scapula. This surface map is then analysed using surface curvature analysis techniques to identify the key clinical parameters associated with scapular dyskinesis. The main advantage of this method is that it provides a measurement tool that may facilitate future quantitative analysis of these key parameters. This may aid with diagnosis and monitoring of the condition by allowing measurement data to be collected both before and after treatment and rehabilitation. We expect that this tool will make the monitoring of treatment effectiveness easier while contributing to diagnostic computer vision.

Context: Scapular motion evaluation is a necessary component of the upper extremity exam. Several methods exist, but most lack good reliability or diagnostic accuracy. The yes/no scapular dyskinesis test has the best of both measures but is untested on inexperienced clinicians. Objective: The purpose of this study was to evaluate the reliability and diagnostic accuracy of the yes/no scapular dyskinesis test when used by graduate assistant athletic trainers. Participants: The participants were college-aged students with no prior history of upper extremity fracture or nerve injury. Data Collection and Results: Participants were evaluated for scapular dyskinesis by a physician and 10 graduate assistant athletic trainers. Ratings were for normal or dyskinetic and then determination of side. Reliability was calculated using Gwet’s AC1 statistic and diagnostic accuracy from standard 2x2 contingency tables. Results: Reliability was moderate (AC1 = 0.48, p < 0.0025, 95% CI [0.147, 0.812]) when side was not accounted for and moderate (AC1 = 0.43, p < 0.0001, 95% CI [0.242, 0.632]) when side-per-side decisions were made. Sensitivity and negative predictive values were low to moderate (34.4%-66.2%, 8.9%-74.1% ). Specificity and positive predictive values were moderate to high (50%-85.2%, 51.5%-95.2%). Accuracy was moderate (65.2%-69.4%) and positive and negative likelihood ratios were low (1.325-2.333, 0.675-0.769). Conclusions: The reliability in this study was on par with previously published studies. Measures of diagnostic accuracy met or exceeded previous results. Clinically, to avoid false negative results and enhance the use of positive results, it appears necessary to combine methods and begin the evaluation with a gross assessment of whether or not dyskinesis is present and if it is to then evaluate which side is dyskinetic.

Rotator cuff disease is multi-factored and has been attributed to both intrinsic and extrinsic factors. Extrinsic factors contribute to compression of the rotator cuff tendons. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. Subacromial impingement is related to factors that encroach upon the subacromial space, while internal impingement affects the articular side of the tendons adjacent to glenoid. While the mechanisms of impingement are varied, further research is necessary to improve treatment and patient outcomes. Chapter 2 is a thorough review of literature on the mechanisms of rotator cuff disease. Alterations in scapular kinematics may influence subacromial space and either contribute to the etiology of subacromial impingement with rotator cuff tendon compression or serve as a compensation to alleviate compression. Furthermore alterations in scapular position may directly influence rotator cuff muscle strength. Chapter 3 compares the influence of the scapular assistance test on scapular upward rotation, posterior tilt, subacromial space, and shoulder strength between healthy individuals and subjects with subacromial impingement syndrome. Scapular upward rotation and posterior tilt induced with scapular assistance test appears to influence subacromial space, but not shoulder muscle strength; however, the influence of these scapular rotations do not differ between asymptomatic individuals and those with subacromial impingement. Furthermore scapular posterior tilt appears to have a greater influence on increasing subacromial space and should be emphasized in the treatment of individuals with subacromial impingement. In chapter 4, we examine the influence that obvious scapular dyskinesis and passive scapular correction with the scapular assistance test have on 3D scapular kinematics and subacromial space. Scapular dyskinesis did not alter scapular kinematics or acromiohumeral distance during active elevation in static positions, in the scapular plane, and without a load when compared to those without scapular dyskinesis. This suggests other contributing factors, such as pain, increased load, or fatigue is requisite to alterations in scapular kinematics or AHD. Passive correction with the scapular assistance test increased scapular upward rotation, posterior tilt, and subacromial space in individuals with and without dyskinesis. In patients with obvious dyskinesis, there was a greater increase in scapular upward rotation with passive scapular assistance. This increased scapular upward rotation had a negative relationship with change in the acromiohumeral distance. The scapular dyskinesis test increased acromiohumeral distance and therefore may be helpful identifying individuals where subacromial compression is producing symptoms, regardless of dyskinesis. The results of this research suggest scapular kinematics and subacromial space are altered with the passive maneuver of the scapular assistance test in all individuals, regardless of subacromial impingement syndrome or scapular dyskinesis. Scapular dyskinesis alone may not be detrimental to scapular position and subacromial space when evaluated in static positions of active arm elevation. Other potential factors may be required to alter scapular kinematics to reduce subacromial space including pain, dynamic movement, load or fatigue. Further study is necessary to determine the influence of the combination of these factors in individuals with scapular dyskinesis.

ABSTRAKT INTRODUKTION: Huvudvärk av spänningstyp (HST) är den vanligaste huvudvärksformen som diagnostiseras och representerar 90 % av fallen som söker sjukvård med huvudvärk och nästan nio av tio kvinnor drabbas av denna typ av huvudvärk någon gång i livet. Skapulär dyskinesi (SD) som beskriver positionsskillnad mellan skulderbladen kan orsakas av olika faktorer och är ett tillstånd som kan vara osymptomatiskt eller symptomatiskt. Den vanligaste orsaken är på grund av svaghet av de viktigaste skulderstabilisatorerna och sambandet mellan HST och SD är att i båda tillstånd ingår träning av styrka och uthållighet av nack- och skulderbladsmuskulatur.   SYFTE: Syftet med arbetet är att undersöka förekomsten av skapulär dyskinesi hos fysisk aktiva kvinnor med huvudvärk av spänningstyp.   METOD: För arbetet rekryterades fysisk aktiva kvinnor med huvudvärk från olika sportföreningar och kvinnor som sökte sig till öppenvården på Aleris Rehab Tullinge. Det användes en enkät som innehöll två delar. Första delen bestod av två frågor från enkäten Neck Disability Index (NDI) som skulle besvaras och andra delen av enkäten fylldes i av undersökaren efter en manuell isometrisk muskeltest av skuldrorna för att diagnostisera SD. Totalt undersöktes 25 kvinnor med huvudvärk. Resultatet sammanställdes i diagram för bättre analys.   RESULTAT: Av 25 fysiska aktiva kvinnor som drabbades av huvudvärk visade 23 kvinnor någon form av SD, vilket motsvarar 92 %. Vilken typ av SD var inte av intresse eftersom syftet var enbart att undersöka förekomsten av SD hos kvinnor med HST.   KONKLUSSION: Fler studier rekommenderas mellan huvudvärk och skapulär dyskinesi eftersom eventuella fynd kan hjälpa fysioterapeuter att ändra eller justera deras träningssätt för att undvika och förebygga HST och SD för bättre prestation av idrottaren.
ABSTRACT INTRODUCTION: Tension type headache (TTH) is the most common type of headache diagnosed and represents 90 % of cases seeking headache healthcare and nearly nine out of ten women suffer from this type of headache sometime in life. Scapular dyskinesia (SD) that describes the position difference between the shoulder blades can be caused by various factors and is a condition that may be symptomatic or symptomatic. The most common reason is the weakness of the main shoulder stabilizers, and the connection between TTH and SD is that in both states it includes training of strength and endurance of the neck and shoulder blades muscles.   OBJECTIVE: The purpose of the work is to investigate the occurrence of scapular dyskinesia in physically active women with tension type headache.   METHOD: For the study, physically active women were recruited with headaches from various sports associations and women who sought outpatient care at Aleris Rehab Tullinge. A survey was used that contained two parts. The first part consisted of two questions from the Neck Disability Index (NDI) questionnaire that were to be answered and the second part of the survey was filled in by the investigator following a manual isometric muscle test of the shoulders to diagnose SD. A total of 25 women with headache were examined. The result was compiled in charts for better analysis.   RESULTS: Of 25 physical active women affected by headache, 23 women showed some form of SD, which represents 92 %. What kind of SD was not of interest because the purpose was to investigate the presence of SD in women with TTH.   CONCLUSION: More studies are recommended between headache and scapular dyskinesia because any findings may help physiotherapists to change or adjust their training methods to avoid and prevent TTH and SD for better athletes performance.

Introduktion: Motorisk kontrollträning bygger på motorisk inlärningsteori och används för att korrigera rörelsemönster. Metoden har utvärderats för nack- och ländryggbesvär men ingen sammanställning har gjorts för skuldran. Syfte: Syftet med denna litteraturstudien var att undersöka vilket vetenskapligt stöd som motorisk kontrollträning har för skuldran och dess påverkan  på funktion, smärta och dyskinesi. Metod: Litteratursökningen gjordes i PubMed, Science Direct, Scopus, PEDro, SPORTDiscus och CINAHL. Sammanställning gjordes efter smärta, funktion och dyskinesi. Resultat: 13 studier inkluderades i denna sammanställning. Fem studier med RCT-design, tre tvärsnittsstudier och två case-studier, en A-B-A-design, en prospektiv single group pre-post design, en single-blind randomized controlled laboratory. Fyra studier hade ett interventionstillfälle och varade upp till en vecka. De övriga nio studierna varade 4-10 veckor. Nio studier identifierades för vardera utfallsmått. Smärta och funktion förbättrades i samtliga studier som undersökte de måtten efter intervention jämfört med baseline. Dyskinesi förbättrades i tre studier, en studie förblev oförändrad medan fem studier visade på blandade resultat för sina utfallsmått. Konklusion: Resultatet av denna litteraturstudie indikerar att motorisk kontrollträning har positiv påverkan på utfallsmåtten smärta och funktion. Gällande dyskinesi sågs positiva tendenser men ingen slutsats kan dras då det är en stor spridning gällande utfallsmått och resultat. Resultatet kan dock inte enbart tillskrivas motorisk kontrollträning. Standardiserade tester och utvärderingsinstrument för dyskinesi efterfrågas samt fler studier som undersöker utfallsmåtten smärta, funktion och dyskinesi tillsammans.

Bakgrund:  Simning är en populär sport. De extrema repetitiva rörelserna som ingår i sporter med majoriteten av rörelserna över huvudet, som exempelvis simning, och otillräcklig stabilitet i axelleden resulterar ofta i överansträngning och skador. Ett vanligt syndrom är impingement och det har rapporterats att 40-91 % av alla simmare har eller upplever problem i axelleden eller de omkringliggande strukturerna. Syfte: Att undersöka om en intervention bestående av övningar för scapulas närliggande muskler i fyra veckor kan påverka upplevd smärta i axel och nacke hos unga simmare. Deltagare: Sexton unga simmare mellan åldrarna (13±2), bestående av (10 flickor och 6 pojkar) deltog. Alla deltagare utförde minst fyra simpass i veckan. Alla deltagare i studien upplever problematik i axel och/eller nacke. Metod: Deltagarna fick fylla i ett (SRQ-S) formulär och genomgå ett Beighton-test. Alla deltagare instruerades i fyra olika övningar, syftet med övningarna var att öka neuromuskulär kontroll och styrka i axelns stabiliserande muskler. Alla övningar skulle utföras innan träningspass, minst en gång om dagen, i fyra veckor. Efter fyra veckors interventionen fick deltagarna fylla i ett nytt (SRQ-S) formulär, den totala poängen innan och efter jämfördes. Resultat:  (SRQ-S) formulären resulterade i en signifikant skillnad (p=0,0005) mellan innan och efter interventionen. Majoriteten av deltagarna rapporterade ett högre välmående i axel och/eller nacke. Konklusion : Majoriteten av deltagarna upplevde minskad problematik i axel och/eller nacke efter fyra veckors interventionen. Det visar på att det finns ett samband mellan ökad axel stabilisering och minskad upplevd smärta i axel/nacke. Dock kan denna studie inte komma till en säker konklusion då vidare undersökning måste göras i detta område.
Background : Competitive swimming is a popular sport. The extreme repetitive motions that overhead-sports implies, like swimming, and inadequate stability in the shoulder joint often results in overexertions and injuries. A common condition is impingement syndrome and it has been reported that 40-91% of all swimmers have or experience problems in the shoulder joint or in the surrounding structures. Purpose : To investigate whether an intervention consisting of exercises for scapulas nearby muscles for four weeks can affect perceived distress in the shoulders and neck of young swimmers. Participants : Sixteen young swimmer between the age of (13±2), consisting of (10 females and 6 males) volunteered to participate. All the participants are performing at least four sessions of swimming a week. All the participants in the study are experiencing trouble in their neck or/and shoulders. Method : The participants had to fill in a (SRQ-S) form and do a Beighton-test. Participants were instructed in four different exercises, the purpose of the exercises were to increase neuromuscular control and strength in the shoulder stabilizing muscles. All exercise were to be performed before every session of swimming, at least once a day, for four weeks. After the four weeks of intervention the participants had to fill in a new (SRQ-S) form, the before and after score were compared. Results : The (SRQ-S) formulas resulted in a significant difference (p=0,0005) between before and after the intervention. The majority of the participants reported also a higher prosperous in their shoulder and/or neck area. Conclusion: The majority of the participant experienced less discomfort in their shoulder and neck area after the four weeks of intervention. There seems to be a relationship between increased shoulder stability and decrease in discomfort in the shoulder/neck. However this study can not come to a secure conclusion and further investigation has to be made in this area.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Introdução: Os desportos que implicam a utilização dos membros superiores apresentam um maior risco, no desenvolvimento de lesões no complexo articular do ombro. Objetivo: verificar se existem alterações na posição escapular, de jogadores de futebol induzidas pela prática desportiva, e se estas influenciam a funcionalidade normal do ombro. Metodologia: Trinta indivíduos dos 16 aos 30 anos, foram divididos em dois grupos de 15, um grupo de futebolistas e outro não futebolistas. Em ambos os grupos foi avaliada a amplitude de rotação interna e externa do ombro, utilizando uma câmara digital e o software Kinovea, e o comprimento muscular do pequeno peitoral. O posicionamento escapular foi observado através da aplicação do Lateral Scapular Slide Test (LSST), com a ajuda de um paquímetro, e por último, foi testada a força isométrica dos rotadores dos ombros através do dinamómetro de força. Resultados: nos dois grupos estudados, não existem diferenças estatisticamente significativas em todas as variáveis observadas (p ≤0,05). No grupo dos futebolistas, verificou-se maior défice nas variáveis estudadas nos jogadores guarda-redes. Conclusão: o futebol não tem grande influência na função do complexo articular do ombro e no posicionamento escapular.
Introduction: The sports which involve the use of the upper limbs present a higher risk in the development of lesions in the shoulder joint complex. Objective: to verify if there are changes in the shoulder position, of footballers induced by sport, and if these influence the normal functionality of the shoulder. Methods: Thirty individuals from 16 to 30 years, were divided into two groups of 15, a group of football players and other non-footballers. In both groups was assessed the extent of internal and external rotation of the shoulder using a digital camera in the software and the muscle length Kinovea little chest. The scapular positioning was observed through the application of Scapular Lateral Slide Test (LSST) with the help of a caliper, and finally tested the isometric strength of the shoulder rotators through the dynamometer. Results: in both groups studied, there are no statistically significant differences in all the variables observed (p ≤ 0.05). The Group of footballers, there was greater deficit in the variables studied in the players. Conclusion: football has no great influence on the function of the shoulder joint and complex in the scapular positioning.
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Bakgrund: Subacromiell smärta är vanligt hos idrottare med repetitivt arbete ovan axelhöjd, vilket kan orsakas av obalans i muskulatur, förändrad position eller inskränkt rörlighet av scapula. Nedsatt funktion av scapula och dess stabilitet kan leda till minskad axelledsrörlighet och försvagad muskultur i området. Träning är förstahandsalternativet för minskad smärta, förbättrad funktion och ökad rörlighet vid subacromiell smärta. Behandling med scapulafokuserad träning har i dagsläget otillräcklig evidens. Mer studier behövs för att avgöra vilken nedsättning av scapula som den typ av träning påverkar och hur olika scapula fokuserade interventioner påverkar subacromiell smärta. Syfte: Syftet med studien var att undersöka effekten av kombinationsövningen ”shoulder dislocations” vad gäller scapulakontroll, aktiv utåtrotation i axelled och smärta hos crossfitutövare med subacromiell smärta. Metod: Single-subject metod med AB design användes till studien. Tre baslinjemätningar och fyra mätningar under interventionsfasen gjordes, där scapulakontrollen och aktiv utåtrotation i axeln mättes samt smärtskattning utfördes. Deltagarna var sin egen kontroll. Populationen var personer som tränade crossfit vid minst tre tillfällen per vecka med subacromiell smärta. Under interventionen utför deltagarna ”shoulder dislocation” tre gånger per vecka med doseringen tio repetitioner i tre set. Resultatet presenterades i grafer och analyserades visuellt. Resultat: Fyra deltagare inkluderades i studien varav en med bilaterala besvär. Samtliga deltagare förbättrade scapulakontrollen, fyra av fem deltagare förbättrade den aktiva utåtrotationen i axelled. Tre av fem deltagare upplevde minskad smärta under träning och vid mättillfället. Slutsats: ”Shoulder dislocation” tycks förbättra scapulakontrollen, aktiv utåtrotation i axelleden hos crossfitutövare med subacromiell smärta och tendens till minskad smärta.
Background: Subacromial pain is common among overhead athletes, which can lead to muscular imbalance, changed position or decreased mobility of scapula. Reduced function and stability of scapula could lead to decreased shoulder mobility and weakened musculature in the area. Exercise is first hand choice to reduce pain, improve function and increase range of motion at subacromial pain. Treatment with scapular focused exercise is today limited. More studies are needed to determine what kind of reduction of scapula this exercise influences and how different scapular focused interventions affect subacromial pain. Aim: The purpose of the study was to examine the effect of the combination exercise ”shoulder dislocations” in terms of scapula control, active external rotation in the glenohumeral joint and pain in crossfit athletes with subacromial pain. Method: Single-subject method with AB design was used in the study. Three baseline measurements and four measurements during the intervention phase was collected, where control of scapula, active external rotation and pain was measured. Participants were their own control. The population was individuals who trained crossfit at least three times a week and had subacromial pain. During the intervention the participants performed ”shoulder dislocations”. Performing three sets of ten repetitions three times a week. The results were presented in graphs and visually analyzed. Results: Four participants were included in the study whereof one had bilateral disorders. All participants increased control of scapula, four out of five increased active external rotation of the glenohumeral joint. Three out of five participants experienced pain reduction during exercise and at the time of measurement. Conclusion: ”Shoulder dislocations” seems to improve control of scapula and active external range of motion of the glenohumeral joint in crossfit athletes with subacromial pain.

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia
Objectivo: O objetivo do presente estudo é averiguar as possíveis diferenças na atividade eletromiográfica dos músculos trapézio superior, trapézio inferior e serrátil anterior entre os participantes que reportaram história de dor na região cervical, comparativamente aos que não reportaram dor na região cervical, assim como entre os participantes que apresentavam discinesia escapular, comparativamente aos que não apresentavam. Metodologia: integraram o estudo 41 participantes de ambos os sexos, com e sem sintomatologia álgica cervical, assim como com e sem discinesia escapular. A atividade eletromiográfica foi avaliada durante uma tarefa de abdução no plano da escápula. Resultados: Não foram observadas diferenças significativas relativamente à actividade electromiogrâfica dos músculos trapézio superior, trapézio inferior e serrátil anterior, entre participantes com e sem cervicalgia e entre participantes com e sem discinesia escapular. Conclusão: A existência de cervicalgia, bem como de discinesia escapular não influencia a actividade elctromiogrâfica dos músculos trapézio superior, trapézio inferior e serrátil anterior na amostra estudada.
Aim: The aim of the present study is to investigate possible differences in electromyographic activity of the upper trapezius, lower trapezius and serratus anterior among participants who reported a history of pain in the cervical region, compared to those who did not report pain in the cervical region, as well as between the participants who presented scapular dyskinesia, compared to those who did not presente the condition. Methodology: 41 participants of both gender, with and without cervical symptomatology, as well as with and without scapular dyskinesia were included in the study. The electromyographic activity was evaluated during a task of abduction in the scapular plane. Results: No statistically significant differences were observed regarding the electromyographic activity of the upper trapezius, lower trapezius and anterior serratus muscles between participants with and without neck pain, and between participants with and without scapular dyskinesia. Conclusion: The existence of neck pain as well as scapular dyskinesia does not influence the elctromiographic activity of the upper trapezius, inferior trapezius and serratus muscles in the present sample.
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碩士
國立臺灣大學
物理治療學研究所
100
Background: Scapular dyskinesis are observable alternations in scapular position and the patterns of motion. Shoulder kinematics and scapular muscular activities alternations were found to be correlated with many shoulder disorders. In previous studies, there were several evaluation methods to assess scapular dyskinesis. However, it was not sufficient; for instance, the scapular displacement from the trunk only provides static measurement, and difficulty of using complicated devices in clinical settings. Therefore, visual-based clinical assessment to identify scapular dyskinesis need to be developed. In this study, we want to develop a novel integrated test to evaluate patients with scapular dyskinesis for clinical use. Objective: The purpose of this study was to investigate the reliability and validity of the novel scapular dyskinesis classification test. Study Design: Sixty subjects with unilateral shoulder pain will be recruited in this study. We used visual-based assessment combined palpation to classify the scapular movement of participants as 8 patterns (3 single abnormal scapular patterns: inferior angle of scapula prominence (pattern I), medial border of scapula prominence (pattern II), superior border of scapula prominence or aberrant scapulohumeral rhythm (pattern III); 4 mixed abnormal scapular patterns: 2 patterns combined (pattern I and II, pattern II and III, pattern I and III) and all 3 patterns combined (pattern I, II, and III); normal scapular movement pattern (pattern IV)) to investigate the reliability and validity of this method. In validity part, we analyzed whether different patterns of scapular dyskinesis corresponding to the alternation of the scapular kinematics and muscular activities. Main outcome measures: (1) 8 patterns of scapular movement (2) Scapular kinematics (scapular upward/ downward rotation, anterior/ posterior tipping and internal/ external rotation, elevation/ depression). (3) Scapular muscular activities (upper/ middle/ lower trapezius and serratus anterior). (4) Muscle force. Results: The novel scapular dyskinesis classification test reached moderate to substantial inter-rater reliability. In validity part, there were less scapular upward rotation (7°) and elevation (1.7 cm) in pattern III group in raising phase, and there was more scapular internal rotation (5°~7°) in pattern II group in lowering phase. Results from EMG data only showed significant difference in serratus anterior muscle (raising: increase 15~19%; lowering: decrease 8%). Conclusion: The novel scapular dyskinesis classification test reached satisfactory reliability. The validity of this test has been demonstrated that the alternations of scapular kinematics were found mostly in specific pattern of scapular dyskinesis group compared with normal pattern group in raising and lowering phase of arm elevation. EMG showed that only the alternation of serratus anterior muscle activity was found, which may be consistent with the fact of distinctive strategy of using scapular muscles by each subject.

博士
國立臺灣大學
物理治療學研究所
105
Scapular dyskinesis was defined as alteration of scapular position and movement relative to thoracic cage. Previous studies demonstrated that 33 to 100 percent of patients with shoulder disorders including rotator cuff injuries, glenohumeral instability, labral tears have scapular dyskinesis, although cause-effect relationship between shoulder disorders and scapular dyskinesis has been still unclear and with conflict findings. Evaluation of scapulothoracic joint is an essential part for restoring shoulder dysfunction in patients with shoulder disorders. Methods to assess scapular dyskinesis include visual observation, corrective maneuvers, measurement of scapular displacement, and complicated tools such as 3-D motion analysis systems. To improve the methods of evaluating scapular dyskinesis, our research in Chapter 1 developed visual observation with palpation methods to classify specific patterns and investigated the reliability of this comprehensive method. Research in Chapter 2 developed modified scapulometer to measure the posterior displacement of medial border and inferior angle of scapula and investigated the reliability and validity of this tool. Understanding the characteristics of specific scapular dyskinesis pattern may help the treatment and prevention of shoulder disorders with scapular dyskinesis. According to the methods developed in Chapter 1, research in Chapter 3 investigated scapular kinematics and associated muscular activation during arm raising/lowering movements in individuals with specific scapular dyskinesis pattern. With more participants recruited, research in Chapter 4 used principal component analysis to assess the movement characteristics of specific dyskinesis pattern in overhead athletes. Additionally, research in Chapter 5 investigated whether shoulder dysfunction were related to unique patterns of scapular dyskinesis and found the related factors associated with shoulder dysfunction in specific scapular dyskinesis pattern. Optimal intervention of scapular dyskinesis requires addressing all of the factors that can create the dyskinesis and then restoring the balance of muscle forces to maintain appropriate scapular position and motion. Clinically, kinesio taping (KT) has been used to restore muscle activities and kinematics but has not been investigated in patients with scapular dyskinesis. Research in Chapter 6 investigated the effects of trapezius kinesio taping on scapular kinematics and associated muscular activities in patients with scapular dyskinesis. In addition, conscious control of the scapular orientation has been believed to improve scapular kinematics and muscle activation. Limited evidence showed the effect of conscious control in symptomatic patients with scapular dyskinesis. Research in Chapter 7 investigated the alteration of scapular kinematics and muscle activation after conscious control of scapula in patients with scapular dyskinesis. According to the findings in Chapter 7, assisted training devices such as real-time video feedback and modifying progressive control program may improve the effect of control in the task of arm elevation in erect position. Final research in Chapter 8 investigated the effect of progressive conscious control of scapular orientation on scapular movements and muscle activation during arm elevation in scapular plane with and without real-time video feedback in patients with subacromial impingement syndrome (SAIS) and medial border of scapula prominence. These chapters included the dimension of evaluation, pattern characteristics and intervention of scapular dyskinesis.

碩士
國立陽明大學
物理治療暨輔助科技學系
100
Background: Scapular dyskinesis is believed to be one causative factor in subacromial impingement syndrome (SIS). Different scapular kinematics was present in previous SIS studies. Reduction in scapular upward rotation (UR), posterior tilt (PT) or external rotation (ER) on scapular kinematics and increased upper treapezius (UT) electromyographic (EMG) activity, decreased lower trapezius (LT) EMG activity or serratus anterior (SA) EMG activity during arm elevation is contributory to the impingement mechanism and can be termed as the proximal-caused scapular dyskinesis (PCSD). However, the validity of scapular dyskinesis screening test such as scapular assistance test (SAT) and scapular retraction test (SRT) was not established, and the clinical and motion characteristics of PCSD were unclear. Purposes: The purposes of the study were to determine (1) the inter-rater reliability and intra-rater reliability of the SAT and SRT, and (2) the construct validity of the two clinical tests through examinating the discriminant validity and hypothesis testing, and (3) clinical and motion characteristics of PCSD inSIS. Methods: First of all, two testers evaluated 12 subjects with SIS separately to exam the inter-rater reliability. One tester evaluated 17 subjects with SIS twice with an interval of 30 minutes for examining the intra-rater reliability. Their results were assessed with weighted kappa and percentage of agreement for estimating inter-rater and intra-rater reliability of SATand SRT. We recruited 44 subjects with SIS and collected data on clinical characteristics such as joint mobility, muscle strength, and posture. Then we collected data on motion characteristics including scapular kinematics and muscle activation. After that, we applied scapular taping to all subjects for correcting PCSD. The motion characteristics were collected again after the taping. We used SAT and SRT to divide the subjects into a PCSD positive and a negative group, then compared the difference in clinical and motion characteristics, as well as the improvement after taping between the two groups using analysis of covariance with repeated measures. Results and Discussion: The inter-rater reliability (Kw=0.75, agreement=91.7%) and intra-rater reliability (Kw＝0.87, agreement=94.1%) of SAT and SRT were substantial. Among the 44 subjects with SIS, half were tested positive and the other half negative. The two groups showed no difference in the basic data except pain duration (p=0.04). The positive group revealed sighificantly decreased scapular UR ( p<0.01), and reduced activation in LT ( p=0.03) and SA ( p=0.02), a features matching the motion characteristics of PCSD; thereby establishing the discriminant validity of the tests. After scapular taping, the positive group showed significantly more increase in UR (p<0.01), as well as activation of LT (p=0.02) and SA (p=0.04), which supported the hypothesis that subjects with PCSD would improve more with an intervention that is know to benefit scapular control. Conclusion and clinical relevance: We have established the reliability and construct validity of the scapular dyskinesis test, which could help to screen subjcts with PCSD that possessed specific clinical and motion characteristics. Appropriate treatments could be administered to help scapular control for these subjects.

碩士
國立陽明大學
物理治療暨輔助科技學系
101
Background: Scapular dyskinesis is associated with subacromial impingement syndrome (SIS). Motor control exercises for scapular stabilizers have shown to reduce pain and disability for patients with SIS. Nevertheless, whether the approach improves the scapular movement patterns and thus reduces the impingement symptoms is unclear. Objective: To compare the effectiveness of exercise intervention with physical-agents therapy for adults with SIS and proximal-cause scapular dyskinesis (PSD). Design: A prospective, double-blind, randomized controlled trial. Methods: Fifty patients with SIS were recruited and randomly assigned into two groups to receive either motor control exercises (MCG) or regular care (RCG). Subjects in each intervention group were further classified into two subgroups, either presence or absence of PSD. Any positive sign of the Scapular Assistance Test, Scapular Retraction Test, or Infraspinatus Scapular Retraction Test indicated PSD. Pain, shoulder function, pain-free elevation angle, flexibility, strength, scapular kinematics and muscle activities were evaluated at baseline and after 12-session intervention by a blinded assessor. The therapist was unaware of the results of the outcome measures until completion of the treatment. Statistical analysis: Two-way repeated measures analysis of covariance (ANCOVA) was performed to explore the group-by-time interaction for all physical examinations. The changes of scapular kinematics and muscle activities were examined by three-way repeated measures ANCOVA. The significance level was set at 0.05. Results: Upon completion of the treatment, significant reduction of pain and disability was reported by both groups. Subjects with PSD in the MCG (n=10) revealed significant greater pain-free elevation angle, total glenohumeral rotation and lower trapezius strength gain as compared to those in the RCG (n=10). In the MCG, individuals with PSD showed significant higher posterior shoulder flexibility than those without PSD (n=15). All other variables yielded modest differences among subgroups. Conclusion: A 12-session exercise or modality therapy was effective to reduce pain and disability for patients with SIS. Additionally, subjects with PSD improved with great pain-free elevation angle after receiving motor control exercises than those receiving regular care.

Thesis title: Effect of targeted training of the lower scapular fixators on the shoulder girdle function of rugby players The concept of the problem: Rugby is one of the toughest ball sports and there is no shortage of injuries. In addition, injuries in the shoulder area are among the most common and any possibility of reducing these injuries is beneficial. There is not much time left for compensation and targeted intervention; moreover, it is not usually led by physiotherapists but by fitness coaches and only in larger clubs. The consequence is a muscle imbalance in the shoulder girdle, which can result in the so-called scapular dyskinesis. This is turn affects the function and stability of the shoulder joint not only by the overhead athletes. It is possible to influence scapular dyskinesis in various ways. One of them is the inclusion of targeted training of lower scapular fixators into fitness training and thus their stability is improved. Objectives: The main aim of this thesis is to verify whether rugby players with painful shoulder have sufficiently scapular fixation based on kinesiological and biomechanical knowledge. Another aim of this thesis is to create such an exercise unit that would ensure the correct activity of the lower scapular fixators and verify this by measurement. The final...