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Factors influencing control of scapular movements in patients with neck and shoulder disorders

29th November 2011

TITLE: Factors influencing the control of scapular movements in patients with neck and shoulder disorders. A preliminary review of the literature.
AUTHOR: Pablo B. Marinho, Kinetic Control Accredited Tutor - Brazil - pbm@pbmesporte.com.br
INTRODUCTION: Data shows that 43-70% of adults will experience at least one episode of neck pain in life. In the year 2000, the direct costs for the treatment of shoulder dysfunctions in the US totaled $7 billion. This data highlights the need for a better understanding of neck and shoulder disorders for the development of more efficient rehab programmes. As the scapula is considered by many authors as the keystone for the neck and shoulder muscles, the 3 objectives of this preliminary literature review are:

(1) to present relevant data on the influence of the scapula and related muscles in the normal function,

(2)to report changes in muscle function around the scapula in subjects with neck and/or shoulder musculoskeletal disorders and

(3)to answer the question: is there evidence that the scapular movement control deficits seen in shoulder disorders occur in neck pain patients?
METHODS: An electronic search was conducted in Medline, Cochrane Library and PEDro. In order to fulfil the objetives, the follow keywords were used in the search: 'neck and shoulder and dysfunction'; 'neck and shoulder and pain'; scapula and dysfunction'; scapula and neck and pain'. Papers from 1997 to 2011 in English were included. Studies related to surgery, diseases, fibromyalgia and not related to musculoskeletal system were excluded.
RESULTS: A preliminary sample of 14 papers were analysed and 3 parameters were created to organize and discuss the studies content and results: Positioning, Kinematic and EMG.
CONCLUSIONS: Altered kinematics are observed with adaptations for sports skills and for compensations to keep function. Compensations may increase the risk of injury and recurrance, so needs to be managed. Some studies demonstrate that scapular dysfunctions, as seen in shoulder disorders, can also be observed in neck related problems. Pain and pathology seems to influence muscle efficiency and postural alignment of the scapula and scapular movement control and alignement training can recover normal muscle efficiency and improve symptoms.

TÍTULO: Fatores influentes no controle dos movimentos da escápula em pacientes com desordens na cervical e no ombro. Uma revisão preliminar da literatura.
AUTOR: Pablo B. Marinho, Kinetic Control Accredited Tutor - Brasil - pbm@pbmesporte.com.br
INTRODUÇÃO: Dados mostram que 43-70% dos adultos irão experimentar pelo menos um episódio de dor cervical. No ano de 2000, os custos diretos com o tratamento de disfunções do ombro nos EUA totalizou 7 bilhões de dólares. Estes dados destacam a importância de uma melhor compreensão das desordens da cervical e do ombro para o desenvolvimento de programas de reabilitação mais eficientes. Como a escápula é considerada por muitos autores como o osso chave para os músculos da cervical e do ombro, os 3 objetivos desta revisão preliminar da literatura são: (1)apresentar dados relevantes da influencia da escápula e seus músculos na função normal, (2)relatar mudanças na função muscular ao redor da escápula em sujeitos com desordens musculoesqueléticas na cervical e no ombro e, (3)responder à seguinte pergunta: existem evidências de que déficits no controle do movimento da escápula encontrados em desordens do ombro também acontecem em pacientes com dor na cervical?.
METODOLOGIA: Uma pesquisa eletrônica foi conduzida no Medline, Cochrane Library e PEDro. Para chegar aos objetivos, os seguintes descritores foram usados na busca: 'neck and shoulder and dysfunction'; 'neck and shoulder and pain'; scapula and dysfunction'; scapula and neck and pain'. Estudos de 1997 a 2011 em inglês foram selecionados. Estudos relacionados à cirurgia, doenças, fibromialgia e não relacionados aos sistema musculoesquelético foram excluídos.
RESULTADOS: Uma amostra preliminar de 14 pesquisas foram analisadas e 3 parâmetros foram criados para organizar e discutir o conteúdo e resultados dos estudos: Posicionamento, Cinemática e Eletromiografia.
CONCLUSÕES: Alterações cinemáticas são normais em adaptações ao gestual desportivo e em compensações para manter a função, mas este último pode aumentar o risco de desenvolvimento de lesões e recorrências, então é preciso ser tratado. Alguns estudos têm demonstrado que disfunções escapulares encontradas nas desordens nos ombros podem também ser encontradas em problemas relacionados à cervical. Dor e patologia parece influenciar a eficiência muscular e alinhamento postural da escápula, mas o treinamento do controle do movimento escapular e o posicionamento próximo ao neutro podem recuperar a eficiência muscular normal e melhorar os sintomas.

 

 

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Keywords: Review 2011