Scapular Dyskinesis, Shoulder Impingement Syndrome
Conditions
Keywords
shoulder impingement syndrome, scapular dyskinesia
Brief summary
The purpose of this study is to compare the prone row exercise, and the lateral pull down exercise, in individuals diagnosed with shoulder impingement syndrome and scapular dyskinesia regarding latissimus dorsi strength, middle trapezius strength, lower trapezius strength, rhomboids strength, Visual analog scale score, Shoulder pain and disability index score and scapular stability test values.
Detailed description
Shoulder impingement syndrome (SIS) is a common musculoskeletal disorder, accounting for approximately 44-65% of all shoulder pain complaints. Normal scapular stability includes the ability to keep the scapula's normal position while the arms are at your sides and throughout all upper-limb movements . The upper, middle, and lower trapezius muscles couple with the serratus anterior and rhomboid muscles to form "force couples," which are thought to be important for appropriate scapular orientation. Scapular dyskinesis occurs when the scapular stabilizing muscles (upper, middle, and lower trapezius, serratus anterior, and latissimus dorsi) are unable to preserve typical scapular movement, and is considered potentially harmful when it results in increased anterior tilting, downward rotation, and protraction, all of which reorient the acromion to reduce the subacromial space width. Bilateral prone rowing has demonstrated clear clinical benefits for patients with subacromial impingement syndrome. In a four week, supervised program where 16 individuals with stage II SIS performed low rowing three times per week, The Lateral Pull down exercise is widely recognized for its activation of the latissimus dorsi, but it also significantly recruits scapular stabilizers such as the lower trapezius and rhomboids, especially when performed with proper scapular depression and retraction. This makes it an effective exercise for improving scapular muscle strength and control in both healthy individuals and those undergoing shoulder rehabilitation . Fifty-four male and female patients, with age between 40-65 years (mean age of 52.5 ± 6.25 years) (Yilmaz et al., 2023), will be recruited through direct referrals from orthopedic doctors. They will be asked to sign the informed consent form. The study will employ a two experimental group protocol. Each group will follow a distinct exercise intervention. Group A will perform the prone row exercise, while Group B will engage in the lateral pull-down exercise. Both groups will also receive selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises . The intervention period will last for 6 weeks, with sessions conducted three times per week under physiotherapist supervision. Outcome measures: 1. Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using handheld dynamometer 2. Function using SPADI 3. Pain using VAS 4. Lateral scapular slide test using Kinovea The results of this study will help determine the most effective exercise approach for improving clinical outcomes in patients with shoulder impingement syndrome and scapular dyskinesia and may provide evidence to guide physical therapy practice.
Interventions
PROCEDUREGroup A will perform the prone row exercise and selected physical therapy treatment
prone row exercise: freely off the side and the head in a neutral position, supported if needed. The starting position involves 90-degree shoulder flexion with full elbow extension (0-degree elbow flexion), transitioning into 0-degree shoulder flexion with 90-degree elbow flexion. From this position, a bilateral vertical pulling movement is performed, involving scapular retraction and shoulder extension against resistance. The motion ends with the elbow flexed at 90 degrees, the shoulder extended, and the scapula fully retracted towards the spine, with control throughout the movement. selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises
PROCEDUREGroup B will receive selected physical therapy treatment and Lateral pull down exercise.
The patient is seated on the pulldown machine with an upright trunk and feet flat on the floor, maintaining a stable posture. The starting position includes gripping the straight bar with a wide overhand (pronated) grip, marked to ensure a between-hands distance equal to 1.6 times the biacromial distance which is the horizontal distance between the most lateral points of the right and left acromion processes (shoulder tip). From this position, the participant performs a downward pulling movement, bringing the bar down in front of the face toward the upper chest near the clavicle in a smooth and controlled manner. selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The study will employ a two experimental group protocol. Participants will be randomly allocated into two groups using the lottery method. Folded papers labeled with group codes will be placed in a container and picked at random by an independent person. This simple randomization ensures equal allocation probability and minimizes selection bias.
Eligibility
Sex/Gender
ALL
Age
40 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* -Fifty-four male and female. * Individuals diagnosed with SIS and aged between 40-65 years with right-hand dominance (Andrea et al., 2024). * Participants experiencing shoulder pain persisting for a minimum duration of 3 months (Lucas et al., 2022). * Subjects with a primary complaint of shoulder impingement and scapular dyskinesia according to Neer's classification specifically in stages I and II are referred by an orthopedist (El Melhat et al., 2025). * Body mass index (BMI) is ≥ 25 kg/m² (Maryam et al., 2023). * Individuals with a positive Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Kibler, 2003; Odom, 2001). * All participants must have the cognitive ability to understand instructions and provide informed consent, consistent with standards highlighted in recent informed consent meta-analyses (Tam et al., 2015).
Exclusion criteria
* History of shoulder surgery, dislocation, or fracture (Crawshaw et al., 2010). * History of neurological disorders (Crawshaw et al., 2010). * Participants will be excluded if they had cervical spine pain or any signs of cervical radiculopathy (Magee, 2014). * Individuals with chronic low back pain will be also excluded (Mohamed et al., 2022). * Pregnant women will be excluded from participation in this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Function using SPADI | (pre-intervention) and after 6 weeks (post-intervention) | Shoulder pain and disability index (SPADI) is demonstrated to be a validated and reliable measure of shoulder pain and disability (Roach et al., 1991). The translated version of SPADI in the Arabic language showed excellent internal consistency and test-retest reliability and construct validity based on substantial correlations of Arabic SPADI with Quick DASH, NRS, and active shoulder ROM. SPADI is recommended for the evaluation of patients with shoulder dysfunction (Alsanawi et al.,2015) |
| Lateral scapular slide test | (pre-intervention) and after 6 weeks (post-intervention) | Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Odom, 2001; Kibler, 1998). |
| Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using Handheld dynamometer (HHD) | (pre-intervention) and after 6 weeks (post-intervention) | Lafayette HHD revealed mostly good to excellent reliability (coefficients ≥ 0.70) for all LL muscles measurements. Also, it has good validity for most measures of isometric LL strength and power in healthy population. Lafayette HHD is a reliable instrument to measure the foot and ankle strength of young and older adults, for both intra-rater (ICC (3,1) = 0.78-0.94) and interrater (ICC (3,1) = 0.77-0.88) comparisons. (Celik et al., 2012). |
| Pain using the Visual Analogue Scale (VAS) | (pre-intervention) and after 6 weeks (post-intervention) | The Visual Analogue Scale (VAS) will be used to measure pain. The VAS is a straight line, with one end representing 0 (no pain) and the other end representing 10 (worst pain possible). The number 0 indicates no problem, and 10 represents the worst possible condition (Huskisson, 1974). |
Countries
Egypt
Contacts
CONTACTmennatallah maher, MSc
Outcome results
None listed