Effects of Scapular Stabilization Exercises and Scapular Proprioceptive Neuromuscular Facilitation Technique on Pain, Range of Motion, Functionality, Scapular Dyskinesia and Proprioception in Patients With Rotator Cuff Lesions

This study aimed to compare the effects of Scapular Proprioceptive Neuromuscular Facilitation (PNF) applications and Scapular Stabilization exercises on pain, joint range of motion, functionality, scapular dyskinesia, and proprioception in individuals with rotator cuff lesions. The study included 30 volunteer participants aged 18 to 65 years, who had been diagnosed with Rotator Cuff Lesion and reported shoulder pain. The Scapular Stabilization group (n=15) received scapular stabilization exercises in addition to conventional treatment, while the PNF group (n=15) received scapular PNF patterns and techniques in addition to conventional treatment. In this study, the Visual Analog Scale (VAS) was used to evaluate the pain severity of individuals, a universal goniometer was used to measure joint range of motion, and the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) was used to assess functional status. Scapular dyskinesia was evaluated using the Lateral Scapular Shift Test (LSKT) and Scapular Dyskinesia Test (SDT), while proprioception was assessed using the Active Angle Repetition Test. Statistical analysis of the data was performed using SPSS V.27 software.

The shoulder joint, also known as the glenohumeral joint, is a dynamic structure that can move in the sagittal, vertical and transverse planes, offering the widest range of motion in the human body. The humeral head articulates with the glenoid fossa of the scapula to form the glenohumeral joint, which is the main joint of the shoulder girdle. The glenohumeral system allows movement in multiple axes thanks to static and dynamic stabilizing structures, but the flexibility of these structures increases the risk of shoulder instability. The scapula is a triangular-shaped bone that supports shoulder functions, which are the cause of anatomy and biomechanical properties; It acts as a platform to which the muscles are attached, connecting the glenohumeral joints to the body and the glenohumeral joints. In a healthy shoulder girdle, the scapula should provide a stable base and the scapular muscles should provide a dynamic position during shoulder joint movements.

Rotator cuff muscles are an important muscle group that plays a role in scapular stabilization by coordinating this dynamic balance with glenohumeral extension strength and is a training aid for scapulohumeral rhythm. Weakness or dysfunction in the scapular muscles disrupts the scapulohumeral rhythm and becomes open to sports in the glenohumeral regions, which play an important role in daily living activities (ADL). The most common degenerative sports seen around the glenohumeral joints are Rotator Cuff Lesions and those that can be found completely or partially according to the parts of the lesions. The risk of occurrence continues to increase with age; It is seen at a rate of 4% in individuals aged 40 and over, while it is seen at a rate of 54% in individuals aged 60 and over. Individuals with rotator cuff pain in the shoulder, the range of motion in between, and the average duration are observed as if they were not impaired. In cuff lesions, the function of the structures responsible for the stabilization of the scapula cannot be performed due to the decrease in the biomechanics of the scapula and the functionality is negatively affected. Rotator cuff lesions can be treated with conservative or surgical intervention. The age of the patient, general health status, aging of the lesion and its functioning are the completion of the treatment accumulation of parts. In cuff lesions, conservative cuts such as medical treatment and physiotherapy applications are usually preferred first, but surgical interventions can be resorted to in cases where this treatment is insufficient. Conservative management of rotator cuff lesions, additional range of motion exercises, stretching and strengthening routines, manual therapy techniques, hot-cold applications or different treatment methods such as transcutaneous electrical nerve stimulation (TENS) can be used. Scapular stabilization exercises are a group of exercises that support shoulder functions and ensure continuity of scapular movement by ensuring that the scapula and humerus work in harmony. This group of exercises should be added to the treatment to regulate the scapulohumeral rhythm affected by rotator cuff lesions and to reactivate normal shoulder capacity. Proprioceptive neuromuscular facilitation (PNF) treatments, which help facilitate neuromuscular mechanism responses by stimulating proprioceptors, are also planned as a treatment approach for neuromuscular treatment of the scapula with the inclusion of conservative treatment methods.

There are studies in the literature on shoulder PNF pattern and techniques and scapular stabilization exercises in individual parts with rotator cuff lesions. However, it has been observed that the treatment of scapular PNF pattern and techniques and scapular stabilization exercises and the symptoms comparing the effectiveness of these two treatment approaches on the effect are not sufficient.

The purpose of this process is to compare whether the scapular stabilization exercises and scapular PNF pattern and techniques on the sound, range of motion of the joints, functionality, scapular dyskinesia and proprioception in individuals with rotator cuff parts and the support of these two treatment approaches.

Eligibility Criteria:
Inclusion Criteria:

* Being between 18 - 65 years of age
* Getting a diagnosis of Rotator Cuff Lesion,
* Presence of unilateral shoulder pain for a minimum of 3 weeks,
* Signing the "Informed Voluntary Consent Form",
* Individuals who are cooperative and willing to participate in the study.

Exclusion Criteria:

* Corticosteroid treatment or local corticosteroid injections in the last three months,
* Neer Stage 3 tear of the rotator cuff tendons,
* Shoulder fracture or instability,
* Physiotherapy within the last 6 months on the same shoulder,
* History of surgery in the shoulder girdle or thorax,
* With cognitive and mental problems,
* Individuals with malignancy, neuromuscular disorders, unstable angina, arthritis, cardiopulmonary disorders, vertigo or various vestibular system disorders and communication problems.