Terapia Fisica

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Manual Therapy 16 (2011) 155e160

Contents lists available at ScienceDirect

Manual Therapy
journal homepage: www.elsevier.com/math

Original article

Scapular positioning and motor control in children and adults: A laboratory study using clinical measuresq,qq
Filip Struyf a, b, Jo Nijs a, b, *, Stijn Horsten a, Sarah Mottram c, Steven Truijen a, Romain Meeusen b
a

Division ofMusculoskeletal Physiotherapy, Department of Health Sciences, Artesis University College Antwerp, Antwerp, Belgium Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium c Kinetic Control, UK
b

a r t i c l e i n f o
Article history: Received 14 May 2009 Received in revised form 9 August 2010 Accepted 14 September 2010Keywords: Scapula Shoulder Assessment

a b s t r a c t
Introduction: The scapular muscular system is the major determinant of scapular positioning. In addition, strength and muscular endurance develops from childhood through adolescence. It is not known whether differences in scapular positioning and motor control between adults and children may exist. Methods: Ninety-two shoulders of 46 adults (mean ¼39.4; 18e86 years; SD ¼ 22.5), and 116 shoulders of 59 children (mean ¼ 11.6; 6e17 years; SD ¼ 3.5), were included in the study. Scapular positioning data were collected using a clinical assessment protocol including visual observation of titling and winging, measurement of forward shoulder posture, measurement of scapular upward rotation, and the Kinetic Medial Rotation Test (KMRT). Results: Theobservation protocol for scapular winging and tilting did not show significant differences between adults and children. After controlling for height, forward shoulder posture (relaxed (0.28 cm/cm (0.06) vs. 0.31 cm/cm (0.07) and retracted (0.15 cm/cm (0.05) vs. 0.20 cm/cm (0.06)) were significantly smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upwardrotation (18.6 ; SD 9.6 ) than adults (14.5 ; SD 10.9 ) at 90 shoulder abduction. No significant differences were seen between children (19% positive test) and adults (24% positive test) using the KMRT. Conclusion: Children and adults show significant but small differences in scapular upward rotation and forward shoulder posture. These data provide useful reference values using a clinicalprotocol. Ó 2010 Elsevier Ltd. All rights reserved.

1. Introduction Abnormalities of scapular positioning have been shown in patients with shoulder impingement syndrome, anterior shoulder instability, and postoperative shoulder complaints (Paletta et al., 1997; Lukasiewicz et al., 1999; Ludewig and Cook, 2000; Hébert et al., 2002; Wilgen van et al., 2003). The complex kinematic behaviour of thescapula and shoulder has typically been studied (McKenna et al., 2004), using three-dimensional motion tracking systems. However, these are costly and not readily available for clinical practice (Sugamoto et al., 2002). There is a need for clinical
q We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on anyorganization with which we are associated AND, if applicable, we certify that all financial and material support for this research (e.g., NIH or NHS grants) and work are clearly identified in the title page of the manuscript. qq The study protocol was reviewed and approved by the medical ethics committee of the University Hospital Brussels (2006/138). * Corresponding author. Campus HIKE, Dept G, ArtesisHogeschool Antwerpen, Van Aertselaerstraat 31, 2170 Merksem, Belgium. Tel.: þ3236418265. E-mail address: jo.nijs@artesis.be (J. Nijs).
1356-689X/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.math.2010.09.002

indicators of known reliability and validity that allow clinicians to assess static and dynamic scapular positioning and motor control. These measurements...
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