Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis.

Background: Therapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression). Methods: Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale. Results: From the 8318 records identified, 8 (high to low risk of bias- scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], P = .03, I2 = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: -0.09, 0.73], P = .13, I2 = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] P = .01, I2 = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], P = .01, I2 = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion. Conclusions: Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.

Differences in Trapezius Muscle H-Reflex between Asymptomatic Subjects and Symptomatic Shoulder Pain Subjects.

In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.

The influence of shoulder position during multi-joint exercises in the relative scapular muscles activity in symptomatic and asymptomatic conditions.

BACKGROUND: Scapular muscles changes, as increased upper trapezius activity and decreased middle and lower trapezius and serratus anterior muscle activity, have been demonstrated in shoulder pain specific or non-specific conditions. Shoulder external rotation exercises have been recommended to improve scapular activity in shoulder pain. OBJECTIVE: To evaluate the relative scapular muscles activity during multi-joint exercises combining shoulder external rotation, trunk rotation and scapular squeeze. METHODS: Forty-one participants with and without shoulder pain were assessed in a cross-sectional study. They performed isometric multi-joint exercises at 0∘ and 90∘ of shoulder abduction with and without support. The relative activity of upper, middle, and lower trapezius and serratus anterior (upper/middle and lower portions) was measured through electromyography. The scapular muscular balance was assessed by the ratio between relative activity of the upper trapezius and the other muscles. RESULTS: Both groups presented similar results. The exercise at 90∘ abduction led to increased relative muscle activity against maximal voluntary contraction in both groups for upper trapezius (with support: 4% MVIC, p= 0.001 or 15% MVIC, p< 0.0001; and without support: 11% MVIC, p< 0.0001 or 13%, p< 0.0001, for asymptomatic and symptomatic group, respectively) and lower trapezius (with support: 66% MVIC, p< 0.0001 or 62% MVIC, p< 0.0001, for asymptomatic and symptomatic group.

A Machine Learning App for Monitoring Physical Therapy at Home.

Shoulder rehabilitation is a process that requires physical therapy sessions to recover the mobility of the affected limbs. However, these sessions are often limited by the availability and cost of specialized technicians, as well as the patient's travel to the session locations. This paper presents a novel smartphone-based approach using a pose estimation algorithm to evaluate the quality of the movements and provide feedback, allowing patients to perform autonomous recovery sessions. This paper reviews the state of the art in wearable devices and camera-based systems for human body detection and rehabilitation support and describes the system developed, which uses MediaPipe to extract the coordinates of 33 key points on the patient's body and compares them with reference videos made by professional physiotherapists using cosine similarity and dynamic time warping. This paper also presents a clinical study that uses QTM, an optoelectronic system for motion capture, to validate the methods used by the smartphone application. The results show that there are statistically significant differences between the three methods for different exercises, highlighting the importance of selecting an appropriate method for specific exercises. This paper discusses the implications and limitations of the findings and suggests directions for future research.

Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review.

Several tools have been used to assess muscular stiffness. Myotonometry stands out as an accessible, handheld, and easy to use tool. The purpose of this review was to summarize the psychometric properties and methodological considerations of myotonometry and its applicability in assessing scapular muscles. Myotonometry seems to be a reliable method to assess several muscles stiffness, as trapezius. This method has been demonstrated fair to moderate correlation with passive stiffness measured by shear wave elastography for several muscles, as well as with level of muscle contraction, pinch and muscle strength, Action Research Arm Test score and muscle or subcutaneous thickness. Myotonometry can detect scapular muscles stiffness differences between pre- and post-intervention in painful conditions and, sometimes, between symptomatic and asymptomatic subjects.