ORIGINAL PAPER
Identifying patients with shoulder impingement syndrome who improve with scapular training: a clinical prediction study
1
Department of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
2
Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
3
Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Submission date: 2023-12-29
Acceptance date: 2024-04-05
Publication date: 2025-03-20
Corresponding author
Ahmed M. El Melhat
Department of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Cairo University, 7 Ahmed Zayat St.11432, Al Dokki, Giza, Egypt; Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, 1 University St., Tarik El Jadida, Riad El Solh 11072809, Beirut, Lebanon
Department of Physical Therapy for Musculoskeletal Disorders and their Surgeries, Faculty of Physical Therapy, Cairo University, 7 Ahmed Zayat St.11432, Al Dokki, Giza, Egypt; Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, 1 University St., Tarik El Jadida, Riad El Solh 11072809, Beirut, Lebanon
Physiother Quart. 2025;33(1):109-116
KEYWORDS
TOPICS
ABSTRACT
Introduction:
There is a preponderance of evidence that scapular training improves scapular muscle performance and decreases the clinical symptoms related to subacromial impingement syndrome (SAIS). To investigate if pain severity, functional disability, scapular upward rotation angle, and upper trapezius/serratus anterior (UT/SA) isometric strength ratio at baseline assessment can predict a patient’s response to scapular training in cases of SAIS.
Methods:
A clinical predictive study was performed on forty-five patients, suffering from SAIS, the assessment included pain severity, disability assessment, scapular upward rotation, and the UT/SA isometric strength ratio. Measurements were collected before and after a 4-week intervention program of scapular muscle training and strengthening of the serratus anterior muscle. The sensitivity and specificity of interfering with this procedure were utilized to identify items included in the clinical prediction rule (CPR).
Results:
Excellent results were shown by the area under the receiver operating characteristic curve (ROC curve) with a pain severity of 0.93 (sensitivity 0.9, specificity 0.33), functional disability of 0.94 (sensitivity 0.956, specificity 0.156), and UT/SA isometric strength ratio of 0.9 (sensitivity 0.9, specificity 0.33) and poor results with a scapular upward rotation angle of 0.66 (sensitivity 0.62, specificity 0.36) as static positioning of the scapula was believed not to be adequate in assessing prediction values, and with the upward scapular rotation angle recently being highlighted as not affecting symptoms of SAIS.
Conclusions:
This study revealed that shoulder pain, functional disability, and UT/SA isometric strength ratios potentially serve as predictors of the efficacy of a scapular training program in patients who suffer from SAIS.
There is a preponderance of evidence that scapular training improves scapular muscle performance and decreases the clinical symptoms related to subacromial impingement syndrome (SAIS). To investigate if pain severity, functional disability, scapular upward rotation angle, and upper trapezius/serratus anterior (UT/SA) isometric strength ratio at baseline assessment can predict a patient’s response to scapular training in cases of SAIS.
Methods:
A clinical predictive study was performed on forty-five patients, suffering from SAIS, the assessment included pain severity, disability assessment, scapular upward rotation, and the UT/SA isometric strength ratio. Measurements were collected before and after a 4-week intervention program of scapular muscle training and strengthening of the serratus anterior muscle. The sensitivity and specificity of interfering with this procedure were utilized to identify items included in the clinical prediction rule (CPR).
Results:
Excellent results were shown by the area under the receiver operating characteristic curve (ROC curve) with a pain severity of 0.93 (sensitivity 0.9, specificity 0.33), functional disability of 0.94 (sensitivity 0.956, specificity 0.156), and UT/SA isometric strength ratio of 0.9 (sensitivity 0.9, specificity 0.33) and poor results with a scapular upward rotation angle of 0.66 (sensitivity 0.62, specificity 0.36) as static positioning of the scapula was believed not to be adequate in assessing prediction values, and with the upward scapular rotation angle recently being highlighted as not affecting symptoms of SAIS.
Conclusions:
This study revealed that shoulder pain, functional disability, and UT/SA isometric strength ratios potentially serve as predictors of the efficacy of a scapular training program in patients who suffer from SAIS.
REFERENCES (45)
1.
Horowitz EH, Aibinder WR, Shoulder impingement syndrome. Phys Med Rehabil Clin. 2023;34(2):311–34; doi: 10.1016/j.pmr.2022.12.001.
2.
Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.
3.
Castaldo M, De Angelis D’Ossat A, Gnessi P, Galeoto G. A systematic review on low-level laser therapy in the management of shoulder impingement syndrome. Appl Sci. 2023;13(6):3536–47; doi.org/10.3390/app13063536.
4.
El Melhat AM, Abbas RL, Zebdawi MR, Ismail AMA. Effect of adding thoracic manipulation for the management of patients with adhesive capsulitis: a randomized clinical trial. Physiother Theory Pract. 2024:1–14; doi: 10.1080/09593985.2024.2316897.
5.
Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013;47(14):877–85; doi: 10.1136/bjsports-2013-092425.
6.
Harput G, Guney-Deniz H, Düzgün İ, Toprak U, Michener LA, Powers CM. Active scapular retraction and acromiohumeral distance at various degrees of shoulder abduction. J Athlet Train. 2018;53(6):584–9; doi: 10.4085/1062-6050-318-17.
7.
Ellenbecke TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010;44(5):319–27; doi: 10.1136/bjsm.2009.058875.
8.
Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthop Res Rev. 2018:83–91; doi: 10.2147/ORR.S157864.
9.
Gebremariam L, Hay EM, van der Sande R, Rinkel WD, Koes BW, Huisstede BMA. Subacromial impingement syndrome – effectiveness of physiotherapy and manual therapy. Br J Sports Med. 2014;48(16):1202–8; doi: 10.1136/bjsports-2012-091802.
10.
Moezy A, Sepehrifar S, Dodaran MS. The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Med J Islam Repub Iran. 2014;28:87.
11.
Shah M, Sutaria J, Khant A. Effectiveness of scapular stability exercises in the patient with the shoulder impingement syndrome. Indian J Phys Ther. 2014;2(1):80–4.
12.
Aytar A, Baltaci G, Uhl TL, Tuzun H, Oztop P, Karatas M. The effects of scapular mobilization in patients with subacromial impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial. J Sport Rehabil. 2015;24(2):116–29; doi: 10.1123/jsr.2013-0120.
13.
Espinoza HG, Araya-Quintanilla F, Pinto-Concha S, Valenzuela-Fuenzalida J, López-Gil JF, Ramírez-Velez R. Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial. BMJ Open Sport Exerc Med. 2023;9(3):e001646; doi: 10.1136/bmjsem-2023-001646.
14.
Cools AM, Vincent Dewitte, Lanszweert F, Notebaert D, Roets A, Soetens B, Cagnie B, Witvrouw EE. Rehabilitation of scapular muscle balance: which exercises to prescribe?. Am J Sports Med. 2007;35(10):1744–51; doi: 10.1177/0363546507303560.
15.
Childs JD, Cleland JA. Development and application of clinical prediction rules to improve decision making in physical therapist practice. Phys Ther. 2006;86(1):122–31; doi: 10.1093/ptj/86.1.122.
16.
Yoo EW, Kennedy-Spaien E, Lueck M. Rehabilitation approaches to spine care: physical therapy, occupational therapy, and aquatic therapy. In: Mao J. (ed.) Spine Pain Care. A Comprehensive Clinical Guide. Cham: Springer; 2020: pp. 453–60; doi: 10.1007/978-3-030-27447-4_34.
17.
ElMelhat AM, Shalash KA, Chabara AEA, Azzam AH, Mohamed NA. Identifying female responders to proximal control exercises in patellofemoral pain syndrome: a clinical prediction rule. J Taibah Univ Med Sci. 2022;17(6):954; doi: 10.1016/j.jtumed.2022.05.008.
18.
Shalash KA, Chabara AR, Azzam AH, Mohamed NA, ElMelhat AM. Is there a subgroup of females with patellofemoral pain syndrome likely to benefit from proximal control exercises?. Physiother Q. 2024;32(1):43–9; doi: 10.5114/pq.2024.135421.
20.
Surenkok O, Aytar A, Baltaci G. Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial. J Sport Rehabil. 2009;18(4):493–501; doi: 10.1123/jsr.18.4.493.
21.
Beattie P, Nelson R. Clinical prediction rules: what are they and what do they tell us?. Aust J Physiother. 2006;52(3):157–63; doi: 10.1016/s0004-9514(06)70024-1.
22.
Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Yl. Development of a shoulder pain and disability index. Arthritis Rheum. 1991;4(4):143–9.
23.
Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis Care Res. 2009;61(5):623–32; doi: 10.1002/art.24396.
24.
Alsanawi HA, Alghadir A, Anwer S, KE, Alawaji A. Cross-cultural adaptation and psychometric properties of an Roach Arabic version of the Shoulder Pain and Disability Index. Int J Rehabil Res. 2015;38(3):270–5; doi: 10.1097/MRR.0000000000000118.
25.
Guermazi M, Ghorbel S, Yahia A, Khmekhem M, Elleuch M.H. Arabic translation and validation of the SPADI index. Ann Phys Rehabil Med. 2011;54(suppl 1):e244; doi: 10.1016/j.rehab.2011.07.349.
26.
Watson L, Balster SM, Finch C, Dalziel R. Measurement of scapula upward rotation: a reliable clinical procedure. Br J Sports Med. 2005;39(9):599–603; doi: 10.1136/bjsm.2004.013243.
27.
Struyf F, Jo Nijs, Mottram S, Roussel NA, Cools AMJ, Meeusen R. Clinical assessment of the scapula: a review of the literature. Br J Sports Med. 2014;48(11):883–90; doi: 10.1136/bjsports-2012-091059.
28.
Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther. 2005;85(11):1128–38.
29.
Tyler TF, Nahow RC, Nicholas SJ, McHugh MP. Quantifying shoulder rotation weakness in patients with shoulder impingement. J Shoulder Elbow Surg. 2005;14(6):570–4; doi: 10.1016/j.jse.2005.03.003.
30.
Çelik D, Dirican A, Baltaci G. Intrarater reliability of assessing strength of the shoulder and scapular muscles. J Sport Rehabil. 2012;21(1):1–5; doi: 10.1123/jsr.2012.TR3.
31.
Cools A, Declercq GA, Cambier DC, Mahieu NN, Witvrouw EE. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports. 2007;17(1):25–33; doi: 10.1111/j.1600-0838.2006.00570.x.
32.
De Mey K, Danneels Lieven A, Cagnie B, Huyghe L, Seyns E, Cools AM. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography. J Orthop Sports Phys Ther. 2013;43(1):3–10; doi: 10.2519/jospt.2013.4283.
33.
Escalante G, Fine D, Ashworth K, Kolber MJ. Progressive exercise strategies to mitigate shoulder injuries among weight-training participants. Strength Cond J. 2021;43(1):72–85; doi: 10.1519/SSC.0000000000000547.
34.
Kashif M, Mustafa R, Bunyad S, Aslam N, Arshad F, Umar B. Physical rehabilitation for Parkinson’s disease: assessment and treatment preferences of physical therapists. Physiother Q. 2023;31(4):70–80; doi: 10.5114/pq.2023.125165.
35.
Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407–15; doi: 10.1016/0197-2456(89)90005-6.
36.
de la Barra Ortiz HA, et al., Efficacy of diadynamic currents in the treatment of musculoskeletal pain: a systematic review. Physiother Q. 2023;31(3):1–19; doi: 10.5114/pq.2023.117021.
37.
De la Barra Ortiz HA, Castillo RC, Zarraonandia MD, Cáceres IR, Ramírez VR. Comparison of the effectiveness of electrolysis and microelectrolysis in the treatment of musculoskeletal pain: a systematic review. Physiother Q. 2023;31(1):73–89; doi: 10.5114/pq.2023.123528.
38.
Reijneveld EA, Noten S, Michener LA, Cools A, Struyf F. Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review. Br J Sports Med. 2017;51(5):436–41; doi: 10.1136/bjsports-2015-095460.
39.
Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24(3):173–9; doi: 10.3233/BMR-2011-0291.
40.
Chester R, Shepstone L, Daniell H, Sweeting D, Lewis J, Jerosch-Herold C. Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: a systematic review. BMC Musculoskelet Disord. 2013;14(1):1–16; doi: 10.1186/1471-2474-14-203.
41.
Juul-Kristensen B, Larsen CM, Eshoj H, Clemmensen T, Hansen A, Jensen PB, Boyle E, Søgaard K. Positive effects of neuromuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome: a randomised controlled trial. J Electromyogr Kinesiol. 2019;48:161–8; doi: 10.1016/j.jelekin.2019.07.009.
42.
Hotta GH, Santos AL, McQuade KJ, de Oliveira AS. Scapular-focused exercise treatment protocol for shoulder impingement symptoms: three-dimensional scapular kinematics analysis. Clin Biomech. 2018;51:76–81; doi: 10.1016/j.clinbiomech.2017.12.005.
43.
Elmelhat AM, Abdelmagid SF, Gomaa EF, Gad AM. Changes in rotator cuff strength ratio, shoulder pain and disability after cervicothoracic mobilization in subjects with shoulder impingement syndrome. Fizjoter Pol. 2020;20(1):36–42.
44.
Phadke V, Camargo P, Ludewig P. Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement. Braz J Phys Ther. 2009;13:1–9; doi: 10.1590/S1413-35552009005000012.
45.
Lawrence RL, Braman JP, Ludewig PM. The impact of decreased scapulothoracic upward rotation on subacromial proximities. J Orthop Sports Phys Ther. 2019;49(3):180–91; doi: 10.2519/jospt.2019.8590.
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