Interrater Reliability of the Clinical Examination of Muscular Scapular Stabilisation
Stefan ABT1,2, Katja Rüegg1,3, André Meichtry1 and Hannu Luomajoki1*
1School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
2Sports Medical Center, Grüzefeldstrasse, Winterthur, Switzerland
3Triemli Hospital Physiotherapy, Birmensdorferstrasse, Zurich, Switzerland
*Corresponding Author: Hannu Luomajoki, School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.
June 27, 2022; Published: July 26, 2022
The objective of this study was the assessment of the interrater reliability of four tests of the resting scapula and five tests of muscular stabilisation of the scapula with a total of 65 subjects without using any quantitative measuring devices.
A visual and palpatory examination of the resting scapula was made with regard to observation features such as acromion level in relation to the angulus superior, scapular winging, the shape of the margo medialis and the scapular tilt. The trapezius as a whole, the trapezius ascendens and serratus anterior muscles were tested with manual resistance for their scapular stabilisation capacity. The trapezius descendens was tested for active sufficiency.
The shoulder shrug test with a wKappa coefficient of 1.0 (95% CI: 1.0) on the right, as well as the scapular tilt test with a wKappa coefficient of 0.65 (95% CI: 0.41-0.89) on the left and a wKappa coefficient of 0.64 (95% CI: 0.40-0.87) on the right, were the most reliable tests. The rest of the assessed tests showed poor to average congruence. Based on these results, an examination of the scapula has to be critically evaluated in daily clinical practice.
Keywords: Shoulder; Scapula; Physical Examination; Interrater Reliability
- Burkhart SS., et al. “The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation”. Arthroscopy 6 (2003): 641-661.
- Mell AG., et al. “Effect of Rotator Cuff Pathology on Shoulder Rhythm”. Journal of Shoulder and Elbow Surgery1 (2005): 58s-64s.
- Ludewig PM and JF Reynolds. “The Association of Scapular Kinematics and Glenohumeral Joint Pathologies”. Journal of Orthopaedic and Sports Physical Therapy2 (2009): 90-104.
- Ogston JB and PM Ludewig. “Differences in 3-Dimensional Shoulder Kinematics Between Persons with Multidirectional Instability and Asymptomatic Controls”. The American Journal of Sports Medicine8 (2007): 1361-1370.
- Timmons MK., et al. “Scapular Kinematics and Subacromial-Impingement Syndrome: a Meta-Analysis”. Journal of Sport Rehabilitation 4 (2021): 354-370.
- Kibler WB., et al. “Clinical Implications of Scapular Dyskinesis in Shoulder Injury: the 2013 Consensus Statement From the 'Scapular Summit”. British Journal of Sports Medicine14 (2013): 877-885.
- McClure PW., et al. “Shoulder Function and 3-Dimensional Kinematics in People with Shoulder Impingement Syndrome Before and After a 6-Week Exercise Program”. Physical Therapy9 (2004): 832-848.
- Roy JS., et al. “Effect of Motor Control and Strengthening Exercises on Shoulder Function in Persons with Impingement Syndrome: a Single-Subject Study Design”. Manual Therapy2 (2008): 180-188.
- De Mey K., et al. “Scapular Muscle Rehabilitation Exercises in Overhead Athletes with Impingement Symptoms: Effect of a 6-Week Training Program on Muscle Recruitment and Functional Outcome”. The American Journal of Sports Medicine8 (2012): 1906-1915.
- Huang HY., et al. “EMG Biofeedback Effectiveness to Alter Muscle Activity Pattern and Scapular Kinematics in Subjects with and Without Shoulder Impingement”. Journal of Electromyography and Kinesiology 1 (2013): 267-274.
- Struyf F., et al. “Scapular Positioning and Movement in Unimpaired Shoulders, Shoulder Impingement Syndrome, and Glenohumeral Instability”. Scandinavian Journal of Medicine and Science in Sports3 (2011): 352-358.
- Worsley P., et al. “Motor Control Retraining Exercises for Shoulder Impingement: Effects on Function, Muscle Activation, and Biomechanics in Young Adults”. Journal of Shoulder and Elbow Surgery4 (2013): e11-19.
- Merolla G., et al. “Supraspinatus and Infraspinatus Weakness in Overhead Athletes with Scapular Dyskinesis: Strength Assessment Before and After Restoration of Scapular Musculature Balance”. Musculoskeletal Surgery3 (2010): 119-125.
- Thigpen CA., et al. “Head and Shoulder Posture Affect Scapular Mechanics and Muscle Activity in Overhead Tasks”. Journal of Electromyography and Kinesiology 4 (2010): 701-709.
- Wegner S., et al. “The Effect of a Scapular Postural Correction Strategy on Trapezius Activity in Patients with Neck Pain”. Manual Therapy6 (2010): 562-566.
- Helgadottir H., et al. “Altered Scapular Orientation During Arm Elevation in Patients With Insidious Onset Neck Pain and Whiplash-Associated Disorder”. Journal of Orthopaedic and Sports Physical Therapy12 (2010): 784-791.
- Helgadottir H., et al. “Altered Activity of the Serratus Anterior During Unilateral Arm Elevation in Patients with Cervical Disorders”. Journal of Electromyography and Kinesiology 6 (2011): 947-953.
- Petersen SM and SN Wyatt. “Lower Trapezius Muscle Strength in Individuals with Unilateral Neck Pain”. Journal of Orthopaedic and Sports Physical Therapy 41 (4 (2011): 260-265.
- Sheard B., et al. “Evaluating Serratus Anterior Muscle Function in Neck Pain Using Muscle Functional Magnetic Resonance Imaging”. Journal of Manipulative and Physiological Therapeutics8 (2012): 629-635.
- Zakharova-Luneva E., et al. “Altered Trapezius Muscle Behavior in Individuals With Neck Pain and Clinical Signs of Scapular Dysfunction”. Journal of Manipulative and Physiological Therapeutics 5 (2012): 346-353.
- Tate AR., et al. “A Clinical Method for Identifying Scapular Dyskinesis, Part 2: Validity”. Journal of Athletic Training2 (2009): 165-173.
- Tate AR., et al. “Effect of the Scapula Reposition Test on Shoulder Impingement Symptoms and Elevation Strength in Overhead Athletes”. Journal of Orthopaedic and Sports Physical Therapy1 (2008): 4-11.
- Rabin A., et al. “The Interrater Reliability of the Scapular Assistance Test”. Journal of Orthopaedic and Sports Physical Therapy9 (2006): 653-660.
- Seitz AL., et al. “Effects of Scapular Dyskinesis and Scapular Assistance Test on Subacromial Space During Static Arm Elevation”. Journal of Shoulder and Elbow Surgery5 (2012): 631-640.
- Ludewig PMand TM Cook. “Alterations in Shoulder Kinematics and Associated Muscle Activity in People with Symptoms of Shoulder Impingement”. Physical Therapy3 (2000): 276-291.
- Michener LA., et al. “Scapular Muscle Tests in Subjects with Shoulder Pain and Functional Loss: Reliability and Construct Validity”. Physical Therapy11 (2005): 1128-1138.
- Cools AM., et al. “Scapular Muscle Recruitment Patterns: Trapezius Muscle Latency with and Without Impingement Symptoms”. The American Journal of Sports Medicine4 (2003): 542-549.
- Cools AM., et al. “Trapezius Activity and Intramuscular Balance During Isokinetic Exercise in Overhead Athletes with Impingement Symptoms”. Scandinavian Journal of Medicine and Science in Sports1 (2007): 25-33.
- Cools AM., et al. “Isokinetic Scapular Muscle Performance in Young Elite Gymnasts”. Journal of Athletic Training 4 (2007): 458-463.
- Kibler WB and A Sciascia. “Current Concepts: Scapular Dyskinesis”. British Journal of Sports Medicine 5 (2010): 300-305.
- Laudner KG., et al. “Scapular Dysfunction in Throwers with Pathologic Internal Impingement”. Journal of Orthopaedic and Sports Physical Therapy7 (2006): 485-494.
- Kibler WB. “The Scapula in Rotator Cuff Disease”. Medicine and Sport Science 57 (2012): 27-40.
- Kibler WB and J McMullen. “Scapular Dyskinesis and its Relation to Shoulder Pain”. Journal of the American Academy of Orthopaedic Surgeons 2 (2003): 142-151.
- Ebaugh DD., et al. “Effects of Shoulder Muscle Fatigue Caused by Repetitive Overhead Activities on Scapulothoracic and Glenohumeral Kinematics”. Journal of Electromyography and Kinesiology 3 (2006): 224-235.
- Ebaugh DD., et al. “Scapulothoracic and Glenohumeral Kinematics Following an External Rotation Fatigue Protocol”. Journal of Orthopaedic and Sports Physical Therapy8 (2006): 557-571.
- Cools AM., et al. “Scapular Muscle Recruitment Pattern: Electromyographic Response of the Trapezius Muscle to Sudden Shoulder Movement Before and After a Fatiguing Exercise”. Journal of Orthopaedic and Sports Physical Therapy5 (2002): 221-229.
- Hayes K., et al. “Reliability of 3 Methods for Assessing Shoulder Strength”. Journal of Shoulder and Elbow Surgery1 (2002): 33-39.
- Cibulka MT., et al. “A New Manual Muscle Test for Assessing the Entire Trapezius Muscle”. Physiotherapy: Theory and Practice 3 (2013): 242-248.
- DiVeta J., et al. “Relationship Between Performance of Selected Scapular Muscles and Scapular Abduction in Standing Subjects”. Physical Therapy8 (1990): 470-476.
- Sahrmann SA. “Diagnosis and Treatment of Movement Impairment Syndromes”. edition. K. White. 2002, St. Louis, Missouri 63146: Mosby (2002).
- Kibler WB., et al. “Scapular Dyskinesis and its Relation to Shoulder Injury”. Journal of the American Academy of Orthopaedic Surgeons6 (2012): 364-372.
- Sobush DC., et al. “The Lennie Test for Measuring Scapular Position in Healthy Young Adult Females: a Reliability and Validity Study”. Journal of Orthopaedic and Sports Physical Therapy 1 (1996): 39-50.
- Arlotta M., et al. “Selective Recruitment of the Lower Fibers of the Trapezius Muscle”. Journal of Electromyography and Kinesiology3 (2011): 403-410.
- Sim J and CC Wright. “The Kappa Statistic in Reliability Studies: Use, Interpretation, and Sample Size Requirements”. Physical Therapy3 (2005): 257-268.
- Landis JR and GG Koch. “The Measurement of Observer Agreement for Categorical Data”. Biometrics 1 (1977): 159-174.
- Warner JJ., et al. “Scapulothoracic Motion in Normal Shoulders and Shoulders with Glenohumeral Instability and Impingement Syndrome. A Study Using More Topographic Analysis”. Clinical Orthopaedics and Related Research 285 (1992): 191-199.
- Kibler WB. “The Role of the Scapula in Athletic Shoulder Function”. The American Journal of Sports Medicine2 (1998): 325-337.
- Ellenbecker TS., et al. “Reliability of Scapular Classification in Examination of Professional Baseball Players”. Clinical Orthopaedics and Related Research 6 (2012): 1540-1544.
- Hickey BW., et al. “Accuracy and Reliability of Observational Motion Analysis in Identifying Shoulder Symptoms”. Manual Therapy3 (2007): 263-270.
- Kibler WB., et al. “Qualitative Clinical Evaluation of Scapular Dysfunction: A Reliability Study”. Journal of Shoulder and Elbow Surgery6 (2002): 550-556.
- McClure P., et al. “A Clinical Method for Identifying Scapular Dyskinesis, Part 1: Reliability”. Journal of Athletic Training2 (2009): 160-164.
- Uhl TL., et al. “Evaluation of Clinical Assessment Methods for Scapular Dyskinesis”. Arthroscopy 11 (2009): 1240-1248.
- Morais NV and AG Pascoal. “Scapular Positioning Assessment: is Side-to-Side Comparison Clinically Acceptable?” Manual Therapy1 (2013): 46-53.
- Cleland JA., et al. “Interrater Reliability of the History and Physical Examination in Patients with Mechanical Neck Pain”. Archives of Physical Medicine and Rehabilitation 10 (2006): 1388-1395.
- Struyf F., et al. “Scapular-Focused Treatment in Patients with Shoulder Impingement Syndrome: A Randomized Clinical Trial”. Clinical Rheumatology 1 (2013): 73-85.