Proximal myofascial pain in patients with distal complex regional pain syndrome of the upper limb.

BACKGROUND: Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases. AIMS: To evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers' tenderness and allodynia are associated with CRPS. METHODS: A case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test. RESULTS: The prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ2 = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ2 = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ2 = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls. CONCLUSION: There is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.

Comparison of muscular activities between subjects with and without scapular downward rotation impairment during diagonal pattern of exercises.

BACKGROUNDS: One form of abnormal scapular alignment is scapular downward rotation (SDR). Changes in muscle function in SDR have not been clearly identified, and SDR exercises also require investigation. Although a diagonal pattern of exercise is commonly used as part of the exercise protocol, a direct comparison of shoulder and scapular diagonal exercises has not yet been conducted. The objectives of this study were to determine the altered activation of the scapular musculature in the SDR group and to investigate which diagonal pattern of exercise effectively activates the scapular musculature. METHODS: Thirty-two participants (18 in the control group and 14 in the SDR group) volunteered to participate in this study. Electromyographic signals were collected from four muscles, the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD), during standing performance of diagonal shoulder and scapular exercises. RESULTS: The control group showed significantly lower UT activity, UT/LT ratio, and UT/SA values than the SDR group (p < .05). Activation of the AD was significantly higher in the SDR than in the control group (p < .05). SA and AD activation were significantly higher in shoulder diagonal pattern exercises than in scapular diagonal pattern exercises (p < .05). The scapular posterior elevation pattern exercise showed significantly higher UT and LT activities than anterior elevation and shoulder diagonal pattern exercises (p < .05). CONCLUSION: Our findings suggest that reduced activation of the UT could lead to greater activation in the AD in SDR. Scapular posterior elevation exercise is advantageous as selectively activates the trapezius musculature, and shoulder diagonal pattern exercise is advantageous in activating the SA and AD.

Different weight bearing push-up plus exercises with and without isometric horizontal abduction in subjects with scapular winging: A randomized trial.

The aim of the present study was to determine whether the application of isometric horizontal abduction (IHA) differentially affected two weight-bearing push-up plus exercises by examining activation of the scapulothoracic muscles in subjects with scapular winging. Fifteen male subjects performed standard push-up plus (SPP) and wall push-up plus (WPP), with and without IHA. Two-way analyses of variance using two within-subject factors were used to determine the statistical significance of observed differences in upper trapezius (UT), pectoralis major (PM), and serratus anterior (SA) muscle activities and UT/SA and PM/SA muscle activity ratios. UT and SA muscle activities were greater during SPP than WPP. PM muscle activity was lower with IHA application. The UT/SA and PM/SA muscle activity ratios were lower during SPP than WPP. The PM/SA muscle activity ratio was lower with IHA application. The results suggest that IHA application using a Thera-Band can effectively reduce PM muscle activity during SPP and WPP exercises. Moreover, the SPP exercise can be used to increase UT and SA muscle activity and reduce the UT/SA and PM/SA muscle activity ratios in subjects with scapular winging.

A comparison of scapulothoracic muscle electromyographic activity in subjects with and without subacromial impingement syndrome during a functional task.

Shoulder impingement syndrome (SIS) is the common cause of shoulder pain and disability and the individuals suffering from it are usually in different levels of physical activity covering an extensive age range. In spite of limited scientific evidence for an altered motor pattern in the shoulder muscles of patients with SIS, they are frequently referred to physiotherapists in an attempt to optimize coordination and strength of the affected muscles. The aim of this study was to compare scapular muscle activity in a general population of subjects with and without SIS during an arm elevation task executed at different speeds in two load conditions. The study is that of a comparative observational using a simple convenience sampling method, comprising 8 females (31.63 ± 9.39) with SIS and 10 females (29.10 ± 6.57) without SIS, matched in terms of age, body mass index (BMI) and levels of physical activity. The surface EMG (SEMG) of all the trapezius muscles, i.e., -upper fibers (UT), middle fibers (MT), and lower fibers (LT) serratus anterior (SA), and middle deltoid were recorded during shoulder elevation in a scapular plane at three speeds (slow, moderate, and fast) and two load conditions (with and without load). Data were analyzed using independent t-tests and three-factor repeated measures analysis of variance and Bonferroni method for paired comparisons. The EMG tests results in muscle activities revealed no significant differences between the two groups at three speeds, and with and without load. The findings do not support the claim that SIS necessarily accompanies changes in scapula thoracic and glenohumeral muscle activity.