Therapeutic Approaches for Subjects With Scapula Dyskinesis

Study Overview
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Brief Summary
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The investigators will test whether conscious control with manual guides and video or EMG biofeedback will enhance 3-D kinematics of scapula in shoulder dysfunction subjects with different type of scapula dyskinesis. The investigators will also examine how correction of scapular orientation may affect the activation of associated muscles during various dynamic movements in these subjects.

Official Title
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Therapeutic Approaches for Subjects With Scapula Dyskinesis: Conscious Control, EMG Biofeedback Training, and Intensive Scapula-focused Intervention

Conditions
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Shoulder Impingement

Intervention / Treatment
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* Other: Conscious control
* Other: Conscious control+biofeedback


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: At least three positive of five tests, including Neer's test, Hawkin's test, Empty can test, tenderness in tendon of rotator cuff and resisted external test. Each patient will need a prescription of the physician or orthopedic surgeon for diagnosing impingement symptoms Exclusion criteria: - Shoulder pain onset due to trauma, a history of shoulder fractures or dislocation, cervical radiculopathy, degenerative joint disease of the shoulder, surgical interventions on the shoulder, or inflammatory arthropathy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Biofeedback group<br>After 1 minute of rest, participants will perform 6 trials of bilateral, active, weighted arm elevation in the scapular plane and a therapist classifies the scapular motion into specific patterns of scapular dyskinesis. After the evaluation of scapular dyskinesis, the kinematics and surface EMG (sEMG) data will be collected during 5 trials of the same arm movements and 3 selected exercises. | Other: Conscious control+biofeedback<br>* In electromyography (EMG) biofeedback training, electronic equipment is used to reveal instantaneously certain physiological events.<br>|
| Active Comparator: Conscious control group<br>Conscious correction of scapular orientation will be taught to the subjects in the manner described in previous studies. The starting position is determined in each individual by actively positioning the scapula between maximal upward and downward rotation, external and internal rotation, and posterior and anterior tilt. Scapular assistance test (SAT) is also conducted by passively assisting patients' scapula into appropriate position to correct scapula dyskinesis | Other: Conscious control<br>* Conscious control of the scapula is important and can correct neuromuscular coordination as well as strength deficits. The strategy in learning control of scapula into normal orientation can be facilitated by manual guides and/or external cues<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder complex kinematics | Scapular orientation relative to the thorax is described using a Euler angle sequence of rotation about Zs (protraction/retraction), rotation about Y's (downward /upward rotation), and rotation about Xs (posterior/anterior tipping). Scapular elevation is defined as the vertical displacement of the scapular sensor during arm elevation. Humeral orientation relative to the scapula is described using a Euler angle sequence in which the first rotation represents the plane of elevation, the second rotation defines the amount of elevation, and the third rotation describes the amount of axial rotation. | The scapular kinematics will be measured before scapular control and immediately after scapular control | 
| Shoulder associated muscular activities | Full bandwidth sEMG data, captured by data acquisition software (AcqKnowledge, Biopac systems Inc., CA, USA) | The muscle activation will be measured before scapular control and immediately after scapular control | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Forward shoulder posture | The measurement of the distance between the posterior border of the acromion and the table | After subjects are included in the study, the forward shoulder posture will be measured before scapular control, and be done within 2 hours. | 
| Pectoralis minor muscle length | The distance from the fourth rib to the coracoids process will be measured with FASTRAK system with accuracy of 0.08 cm. This distance (in centimeter) is divided by the subjects height and multiplied by 100. This results in a pectoralis muscle length index | After subjects are included in the study, the muscle length will be measured before scapular control, and be done within 2 hours. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder dyskinesis, EMG biofeedback training, Intensive Scapula-focused intervention