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系統識別號 U0026-0812200914230995
論文名稱(中文) 肩關節夾擊症候群之發展: 從肩關節摩擦聲響陽性者之肩胛肌肉失衡與局部控制機制談起
論文名稱(英文) The development of impingement syndrome: The role of muscle imbalance and scapular control in asymptomatic subjects with shoulder crepitus
校院名稱 成功大學
系所名稱(中) 物理治療研究所
系所名稱(英) Department of Physical Therapy
學年度 96
學期 2
出版年 97
研究生(中文) 郭定佾
研究生(英文) Ting-Yi Kuo
學號 t6695101
學位類別 碩士
語文別 中文
論文頁數 112頁
口試委員 指導教授-陳文玲
口試委員-徐阿田
口試委員-周一鳴
中文關鍵字 關節內夾擊  肩峰下夾擊症候群  肩關節摩擦聲響 
英文關鍵字 internal impingement  subacromial impingement syndrome  shoulder crepitus 
學科別分類
中文摘要 摘 要
研究背景及目的:肩峰下夾擊症候群是最常見的肩關節病變,流行率高達44~65%。而另一種常見於過肩運動員之夾擊症為關節內夾擊症候群。一般而言,夾擊症病患除了常見於關節活動度與肩胛肌力方面之改變外,還會出現肩峰下空間減少、肩胛肌肉活動異常、以及肩關節摩擦聲響等症狀。令人驚訝的是,肩關節正常的健康族群中也有高達30%的人會出現肩關節摩擦聲響的症狀,但是至今尚無研究針對已呈現肩關節摩擦聲響的健康人進行相關肩胛肌肉控制與物理性檢查以便比對分析,來檢定肩關節摩擦聲響是否可能正是肩關節夾擊症候群的早發徵狀之一,故本研究之目的在調查肩關節摩擦聲響呈陽性之無肩痛年輕人是否已出現肩胛肌肉失衡與控制改變的現象。
研究方法:本研究分為兩部份進行,第一部份延攬21位單側肩關節摩擦聲響呈陽性反應之年輕無肩痛受試者進行左右兩邊肩關節之比較;第二部份分別於一般無肩痛大學生中延攬慣用側肩關節摩擦呈陽性者27人(包括羽球校隊選手13人,稱羽球陽性組,與非羽球校隊者14人,稱一般陽性組),以及慣用側肩關節摩擦呈陰性者之控制組9人進行三組比較。評估項目包括肩關節活動度(肩外轉、肩內轉)、後側關節囊緊縮程度、靜態頭肩姿勢與肩胛方位、肩胛肌力測量(三角肌中枝、上斜方肌、前鋸肌、下斜方肌、肩外轉肌肩、內轉肌)、以及肩胛平面手臂抬舉與放下過程之肩胛肌(三角肌中枝、上斜方肌、前鋸肌、下斜方肌)肌電訊號評估。第一部份利用成對樣本t檢定進行兩側肩關節間之比較,第二部份利用單因子變異數分析進行三組間之比較。 研究結果:本研究第一部份,摩擦聲響陽性側相較於陰性側,呈現肩內轉肌肌力顯著增加、胸小肌顯著緊縮、上斜方肌徵召起始時間顯著延後、於手臂放下後期與末期(60°~0°)下斜方肌活動強度顯著增加以及於手臂放下後期(60°~30°)下斜方肌之於前鋸肌肌肉活動比值顯著增加的現象。有關第二部份研究結果,一般陽性組相較於控制組,亦於手臂放下後期(60°~30°)呈現下斜方肌活動強度顯著增加之現象。然而羽球陽性組在手臂抬舉初期(0°~30°)與手臂放下後期(60°~30°),下斜方肌活動強度卻顯著小於一般陽性組,且與控制組沒有顯著差異;另一方面,羽球陽性組亦呈現肩外/內轉肌肌力比值顯著偏低、胸小肌顯著緊縮以及靜姿評估項目之肩胛骨向內旋轉角度顯著增加的現象。
結論:本研究之結果指出肩關節摩擦聲響呈陽性反應者或許為了因應肩峰下空間減少之可能性已採取於抬臂過程增加下斜方肌活動強度之代償性動作策略,呈現與肩峰下夾擊症候群患者相似之代償性動作策略;而羽球選手雖未呈現類似代償機制,然而其肩旋轉肌肌力失衡以及肩胛骨向內旋轉角度顯著增加之現象可能造成不同於一般陽性組之典型肩峰下空間減少現象,即旋轉肌與後上側關節唇互相碰撞而增加關節內夾擊症發生之機率。因此,肩關節摩擦聲響所代表的臨床意義相當值得重視,或許已是肩關節夾擊症候群之早發徵兆。
英文摘要 Abstract
Background: Subacromial impingement syndrome is the most common shoulder pathology, and the prevalence is 44~65%. Besides, internal impingement is commonly seen in athletes participating in overhead activities. Previous studies have reported that patients with impingement syndrome often demonstrated altered shoulder range of motion and muscle strength, decreased subacromial space, altered scapular muscle control and crepitus sign during shoulder movement. On the other hand, 30% of young people without shoulder pain were also reported to represent crepitus sign during shoulder movement. However, little has been done with respect to the scapular control strategies of asymptomatic people with shoulder crepitus.
Purpose: The study aimed to identify the alterations in shoulder range of motion, muscle strength, static posture and scapular orientation, and scapular muscle control during arm elevation / lowering by comparing asymptomatic young subjects with shoulder crepitus and the controls.
Methods: The first part of the study recruited 21 asymptomatic young subjects with unilateral shoulder crepitus for bilateral comparisons. The second part recruited 27 asymptomatic college students with shoulder crepitus in their dominant arms (13 badminton players and 14 non-badminton players), and 9 control students without shoulder crepitus for further group comparison. The measurements including shoulder range of motion, the tightness of posterior capsule, head and shoulder posture, static scapular orientation, scapular muscle activities, including deltoid, upper trapezius, serratus anterior and lower trapezius, during arm elevation and lowering movements, and the isometric strength of scapular muscles were performed for all participants. Several paired-sample t tests were conducted for bilateral comparison and one-way ANOVA were conducted for the comparison among badminton, non-badminton and control groups.
Results: The crepitus shoulders were found to demonstrate significantly increased strength of shoulder internal rotators, significantly tighter pectoralis minor, significantly increased onset latency in ipsilateral upper trapezius, significantly greater muscle activities in lower trapezius, and significantly increased lower trapezius relative to serratus anterior ratio during arm lowering process (60°~0°) in comparison of non-crepitus shoulders except for those in badminton group. In addition, the crepitus shoulders in badminton group did not show similar scapular control strategies comparing with the crepitus shoulders in non-badminton player, yet demonstrated significantly decreased strength ratio of external to internal rotator, significantly tighter pectoralis minor, and significantly increased scapular internal rotation in static evaluation of scapular orientation.
Conclusions: Although no pain was complained, similar scapular control strategy to those reported in impinged shoulders, namely increased muscle activities of lower trapezius during arm elevation, were found in asymptomatic young subjects with shoulder crepitus. It might be a kind of compensatory strategy to compromise the decrease of subacromial space. In addition, the badminton players demonstrated different characteristics, especially in significant imbalance of rotators strength and increased scapular internal rotation in static scapular orientation. Considering the alterations of scapular control in badminton players with crepitus, it might lead to atypical alteration of subacromial space comparing with the non-badminton players. It is possible that the crepitus found in our badminton group have provided evidence for excessive contact existing between the rotator cuff and the posterior-superior glenoid labrum, thus increasing the risk of internal impingement. In conclusion, shoulder crepitus might be a critical clinical symptom in young asymptomatic people as well as an early sign of shoulder impingement syndrome.
論文目次 目 錄
中文摘要 ------------------------------------------------------------------------------------------ 3
英文摘要 ------------------------------------------------------------------------------------------ 5
誌謝 ------------------------------------------------------------------------------------------------ 8
目錄 ------------------------------------------------------------------------------------------------ 9
表目錄 ------------------------------------------------------------------------------------------- 15
圖目錄 ------------------------------------------------------------------------------------------- 16
第一章 文獻回顧 ------------------------------------------------------------------------------ 18
1.1 肩關節摩擦聲響之定義 ---------------------------------------------------------- 18
1.2 常見的夾擊症候群 ---------------------------------------------------------------- 18
1.2.1 肩峰下夾擊症候群之定義 ---------------------------------------------- 18
1.2.2 關節內夾擊之定義 ------------------------------------------------------- 19
1.3 常見之肩關節摩擦聲響與其發生率 ------------------------------------------- 20
1.4 肩關節摩擦聲響之致病機轉 ---------------------------------------------------- 21
1.5 肩胛肱骨節律 ---------------------------------------------------------------------- 23
1.5.1 肩胛骨之動作學分析 ---------------------------------------------------- 23
1.5.2 影響肩胛肱骨節律之因素 ---------------------------------------------- 25
1.5.2.1 胸椎與肩胛姿勢 ------------------------------------------------- 25
1.5.2.2組織柔軟度 -------------------------------------------------------- 25
1.5.2.3 肩胛肌肉疲勞 ---------------------------------------------------- 26
1.6 肩關節夾擊症候群之物理性檢查 ---------------------------------------------- 27
1.6.1 肩峰下夾擊症候群 ------------------------------------------------------- 27
1.6.2 關節內夾擊 ---------------------------------------------------------------- 27
1.7 肩關節夾擊症候群之肩胛肱骨節律 ------------------------------------------- 28
1.7.1 肩峰下夾擊症候群於手臂抬舉過程之肩胛骨動作學分析 ------- 28
1.7.1.1 一般性的手臂抬舉控制 ---------------------------------------- 28
1.7.1.2 代償性的手臂抬舉策略 ---------------------------------------- 29
1.7.1.3 手臂放下之動作策略 ------------------------------------------- 30
1.7.2 關節內夾擊之肩胛骨動作學分析 ------------------------------------- 30
1.8 肩胛肌肉之功能 ------------------------------------------------------------------- 31
1.9 肩關節夾擊症候群之肌肉活動情形 ------------------------------------------- 32
1.9.1 肩峰下夾擊症候群手臂抬舉與放下過程之肌肉活動情形 ------- 32
1.9.2 關節內夾擊症於手臂抬舉與等速運動之肌肉活動情形 ---------- 33
1.10 肩關節摩擦聲響之文獻探討 -------------------------------------------------- 35
1.11 總結 -------------------------------------------------------------------------------- 36
1.12 研究動機 -------------------------------------------------------------------------- 37
1.13 研究問題 -------------------------------------------------------------------------- 37
1.14 研究目的 -------------------------------------------------------------------------- 38
1.15 研究假設 -------------------------------------------------------------------------- 38
第二章 研究方法 ------------------------------------------------------------------------------ 40
2.1 研究對象 ---------------------------------------------------------------------------- 40
2.2 研究儀器與設備 ------------------------------------------------------------------- 41
2.2.1 電磁式動作追蹤系統 ---------------------------------------------------- 41
2.2.2 肌電圖儀 ------------------------------------------------------------------- 41
2.2.3 傾角器 ---------------------------------------------------------------------- 42
2.2.4 手持式肌力測試儀 ------------------------------------------------------- 43
2.3 研究流程 ---------------------------------------------------------------------------- 43
2.4 評估項目 ---------------------------------------------------------------------------- 44
2.4.1 關節活動度與後側肩關節囊緊縮程度 ------------------------------- 44
2.4.1.1 肩外轉與肩內轉 ------------------------------------------------- 44
2.4.1.2 後側肩關節囊緊縮程度 ---------------------------------------- 45
2.4.2 肩胛平面手臂抬舉與放下過程之動作測量 ------------------------- 45
2.4.3 肩胛平面手臂抬舉與放下過程之肌電訊號測量 ------------------- 47
2.4.4相關肌肉力量測量 --------------------------------------------------------- 48
2.5 資料處理與分析 ------------------------------------------------------------------- 51
2.5.1 頭肩姿勢與肩胛方位 ---------------------------------------------------- 51
2.5.2 肩胛平面抬舉與放下過程動作分析 ---------------------------------- 55
2.5.3 肌電訊號分析 ------------------------------------------------------------- 56
2.6 研究參數 ---------------------------------------------------------------------------- 57
2.7 資料統計與分析 ------------------------------------------------------------------- 58
第三章 研究結果 ------------------------------------------------------------------------------ 60
2.1 第一部份單側肩關節摩擦聲響之無肩痛年輕人其陽性側與陰性側之比較
------------------------------------------------------------------------------------------- 60
2.1.1 受試者基本資料 ---------------------------------------------------------- 60
2.1.2 陽性側與陰性側之肩關節活動度、後側肩關節囊緊縮程度、與肩
胛肌力之比較 ------------------------------------------------------------- 60
2.1.3 陽性側與陰性側之頭肩姿勢與肩胛方位之比較 ------------------- 61
2.1.4 陽性側與陰性側於手臂抬舉之肩胛肌肉徵召起始時間之比較 --- 62
2.1.5 陽性側與陰性側於手臂抬舉之肩胛肌肉平均活動強度之比較 --- 63
2.1.6 陽性側與陰性側於手臂抬舉過程肩胛肌肉活動比值之比較 ---- 65
2.2 第二部分一般陽性組、羽球組與控制組之比較 ---------------------------- 66
2.2.1 受試者基本資料 ---------------------------------------------------------- 66
2.2.2 一般陽性組、羽球組與控制組於肩關節活動度、後側肩關節囊緊
縮程度、肩胛肌力之比較 ------------------------------------------------ 66
2.2.3 一般陽性組、羽球組與控制組之頭肩姿勢與肩胛方位之比較 ---- 67

2.2.4 一般陽性組、羽球組與控制組於手臂抬舉之肩胛肌肉徵召起始時
間之比較 ------------------------------------------------------------------- 69
2.2.5 一般陽性組、羽球組與控制組於手臂抬舉之肩胛肌肉平均活動強
度之比較 ------------------------------------------------------------------- 69
2.2.6 一般陽性組、羽球組與控制組於手臂抬舉之肩胛肌肉活動比值之
比較 ------------------------------------------------------------------------- 70
第四章 研究討論 ------------------------------------------------------------------------------ 73
4.1 單側肩關節摩擦聲響陽性受試者其陽性側與陰性側之比較 ------------- 73
4.1.1 頭肩姿勢與肩胛方位 ---------------------------------------------------- 73
4.1.2 肩胛肌肉徵召起始時間 ------------------------------------------------- 75
4.1.3 肩胛肌肉平均活動強度與肩胛肌肉活動比值 ---------------------- 76
4.1.4 肩關節活動度與肩胛肌力 ---------------------------------------------- 77
4.2 一般陽性組、羽球組與控制組之比較 ----------------------------------------- 78
4.2.1 受試者之選擇 ------------------------------------------------------------- 79
4.2.2 頭肩姿勢與肩胛方位 ---------------------------------------------------- 80
4.2.3 肩胛肌肉徵召起始時間 ------------------------------------------------- 83
4.2.4 肩胛肌肉平均活動強度與肩胛肌肉活動比值 ---------------------- 84
4.2.5 肩關節活動度與肩胛肌力 ---------------------------------------------- 85
4.3 研究限制 ---------------------------------------------------------------------------- 87
4.4 臨床貢獻 ---------------------------------------------------------------------------- 88
第五章 研究結論 ------------------------------------------------------------------------------ 90
參考文獻 ---------------------------------------------------------------------------------------- 91
附錄一 臨床人體試驗同意書 ------------------------------------------------------------- 109
自述 --------------------------------------------------------------------------------------------- 112
參考文獻 參考文獻
1. Magee DJ. Orthopedic Physical Assessment. 4th ed. Philadelphia: Saunders; 2002.
2. Bilal RHB, Duffy PJ, Shafi BBB, Hafi SBB. Rotator Cuff Pathology. November 7, 2007. Available at: http://www.emedicine.com/orthoped/TOPIC552.HTM.
3. Roy A, Dahan TH, Bélair M, Dahan B. Rotator Cuff Disease. March 22, 2006. Available at: http://www.emedicine.com/PMR/topic125.htm.
4. Rotator Cuff Clinical Presentation: Roughness. January 26, 2005. Available at: http://www.orthop.washington.edu/uw/rotatorcuff/tabID__3376/ItemID__197/PageID__395/Articles/Default.aspx.
5. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics. 2003;18:369-379.
6. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. Journal of Bone and Joint Surgery. 1972;54:41-50.
7. Neer CS. Impingement lesions. Clinical Orthopaedics and Related Research. 1983;173:70-77.
8. Walch G, Boileau P, Noel E, Donell S. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: An arthroscopic study. Journal of Shoulder and Elbow Surgery. 1992;1:238-245.
9. Kvitne RS, Jobe FW. The diagnosis and treatment of anterior instability in the throwing athlete. Clinical Orthopaedics and Related Research. 1993;291:107-123.
10. Jobe CM. Posterior superior glenoid impingement: Expanded spectrum. Arthroscopy. 1995;11(5):530-536.
11. Jobe CM. Superior glenoid impingement. Current concepts. Clinical Orthopaedics and Related Research. 1996;330:98-107.
12. Jobe CM. Superior glenoid impingement. Orthopedic Clinics of North America. 1997;28(2):137-143.
13. Davidson PA, Elattrache NS, Jobe CM, Jobe FW. Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: A new site of impingement. Journal of Shoulder and Elbow Surgery. 1995;4(5):384-390.
14. Halbrecht JL, Tirman P, Atkin D. Internal impingement of the shoulder: Comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 1999;15(3):253-258.
15. Walsworth MK, Doukas WC, Murphy KP, Mielcarek BJ, Michener LA. Reliability and diagnostic accuracy of history and physical examination for diagnosing glenoid labral tears. American Journal of Sports Medicine. 2008;36(1):162-168.
16. Fukuda H, Mikasa M, Yamanaka K. Incomplete thickness rotator cuff tears diagnosed by subacromial bursography. Clinical Orthopaedics and Related Research. 1987;223:51-58.
17. Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS. Results of nonoperative management of full-thickness tears of the rotator cuff. Clinical Orthopaedics and Related Research. 1993;294:103-110.
18. Sizer P, Phelps V, Gilbert K. Diagnosis and management of the painful shoulder. Part 2: Examination, interpretation, and management. Pain Practice. 2003;3(152-185).
19. Gill TJ, Micheli LJ, Gebhard F, Binder C. Bankart repair for anterior instability of the shoulder. Long-term outcome. Journal of Bone and Joint Surgery. 1997;79-A(6):850-857.
20. Rhee YG, Lee DH, Chun IH, Bae SC. Glenohumeral arthropathy after arthroscopic anterior shoulder stabilization. Arthroscopy. 2004;20(4):402-406.
21. Wirth M, Basamania C, Rockwood C. Nonoperative management of full-thickness tears of the rotator cuff. Orthopedic Clinics of North America. 1997;28:57-59.
22. Kazemi M. Degenerative rotator cuff tear in an elderly athlete: A case report. Journal of the Canadian Chiropractic Association. 1999;43(2):104-110.
23. Wallny T, Wagner U, Prange S, Schmitt O, Reich H. Evaluation of chronic tears of the rotator cuff by ultrasound. Journal of Bone and Joint Surgery. 1999;81:675-678.
24. Stetson WB, Templin K. The crank Test, the O'Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. American Journal of Sports Medicine. 2002;30(6):806-809.
25. Karas EH, Iannotti JP. Failed repair of the rotator cuff: Evaluation and treatment of complications. Journal of Bone and Joint Surgery. 1997;79:784-793.
26. Manske RC, Reiman MP, Stovak ML. Nonoperative and operative management of snapping scapula. American Journal of Sports Medicine. 2004;32(6):1554-1565.
27. Tsao BJ, Chen PT, Chen WL. Interscapular muscle strength and related posture in subjects with subacromial crepitus. 55th Conference of Physical Therapy Association of R.O.C. Kaohsiung, Taiwan; 2007.
28. Flatow EL, Soslowsky LJ, Ticker JB, et al. Excursion of the rotator cuff under the acromion: Patterns of subacromial contact. American Journal of Sports Medicine. 1994;22(6):779-788.
29. Poppen NK, Walker PS. Normal and abnormal motion of the shoulder. Journal of Bone and Joint Surgery. 1976;58(2):195-201.
30. Nordt WE, Garretson RB, Plotkin E. The measurement of subacromial contact pressure in patients with impingement syndrome. Arthroscopy. 1999;15(2):121-125.
31. Cathcart CW. Movements of the shoulder girdle involved in those of the arm on the trunk. Journal of Anatomy and Physiology. 1884;18:211-218.
32. Inman VT, Saunders JBdM, Abbott LC. Observations of the function of the shoulder joint. 1944. Clinical Orthopaedics and Related Research. 1996;330:3-12.
33. Sharkey NA, Marder RA. The rotator cuff opposes superior translation of the humeral head. American Journal of Sports Medicine. 1995;23(3):270-275.
34. Thompson WO, Debski RE, Boardman ND, et al. A biomechanical analysis of rotator cuff deficiency in a cadaveric model. American Journal of Sports Medicine. 1996;24(3):286-292.
35. Payne LZ, Deng X-H, Craig EV, Torzilli PA, Warren RF. The combined dynamic and static contributions to subacromial impingement: A biomechanical analysis. American Journal of Sports Medicine. 1997;25(6):801-808.
36. Deutsch A, Altchek DW, Schwartz F, Otis JC, Warren RF. Radiologic measurement of superior displacement of the humeral head in the impingement syndrome. Journal of Shoulder and Elbow Surgery. 1996;5(3):186-193.
37. Chen S-K, Simonian PT, Wlckiewicz TI, Otis JC, Warren RF. Radiographic evaluation of glenohumeral kinematics: A muscle fatigue model. Journal of Shoulder and Elbow Surgery. 1999;8(1):49-52.
38. Codman EA. Rupture of the supraspinatus tendon. 1911. Clinical Orthopaedics and Related Research. 1990;254:3-26.
39. McQuade KJ, Smidt GL. Dynamic scapulohumeral rhythm: The effects of external resistance during elevation of the arm in the scapular plane. Journal of Orthopaedic and Sports Physical Therapy. 1998;27(2):125-133.
40. Lin JJ, Lim HK, Yang JL. Effect of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders. Journal of Orthopaedic Research. 2006;24:1044-1051.
41. Helm Fvd, Pronk G. Three-dimensional recording and description of motions of the shoulder mechanism. Journal of Biomechanical Engineering. 1995;117(1):27-40.
42. Ludewig PM, Cook TM, Nawoczenski DA. Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. Journal of Orthopaedic and Sports Physical Therapy. 1996;24(2):57-65.
43. Lukasiewicz AC, McClure P, Michener L, Praff N, Senneff B. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. Journal of Orthopaedic and Sports Physical Therapy. 1999;29(10):574-586.
44. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy. 2000;80(3):276-291.
45. McQuade KJ, Wei SH, Smidt GL. Effects of local muscle fatigue on three-dimensional scapulohumeral rhythm. Clinical Biomechanics. 1995;10(3):144-148.
46. McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. Journal of Shoulder and Elbow Surgery. 2001;10:269-277.
47. Kebaetse M, McClure P, Pratt NA. Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Archives of Physical Medicine and Rehabilitation. 1999;80:945-950.
48. Finley MA, Lee RY. Effect of sitting posture on 3-dimensional scapular kinematics measured by skin-mounted electromagnetic tracking sensors. Archives of Physical Medicine and Rehabilitation. 2003;84:563-568.
49. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. Journal of Orthopaedic and Sports Physical Therapy. 2005;35(4):227-238.
50. Tsai N-T, McClure PW, Karduna AR. Effects of muscle fatigue on 3-dimensional scapular kinematics. Archives of Physical Medicine and Rehabilitation. 2003;84:1000-1005.
51. McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Physical Therapy. 2004;84(9):832-848.
52. McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Physical Therapy. 2006;86(8):1075–1090.
53. Leroux J-L, Codine P, Thomas E, Pocholle M, Mailhe D, Blotman F. Isokinetic evaluation of rotational strength in normal shoulders and shoulders with impingement syndrome. Clinical Orthopaedics and Related Research. 1994;304:108-115.
54. Tyler TF, Nicholas SJ, Roy T, Gleim GW. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. American Journal of Sports Medicine. 2000;28(5):668-673.
55. Tyler TF, Nahow RC, Nicholas SJ, McHugh MP. Quantifying shoulder rotation weakness in patients with shoulder impingement. Journal of shoulder and elbow surgery. 2005;14(6):570-574.
56. Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. American Journal of Sports Medicine. 2006;34(10):1643-1647.
57. Brown LP, Niehues SL, Harrah A, Yavorsky P, Hirshman HP. Upper extremity range of motion and isokinetic strength of the internal and external shoulder rotators in major league baseball players. American Journal of Sports Medicine. 1988;16(6):577-585.
58. Bigliani LU, Codd TP, Connor PM, Levine WN, Littlefield MA, Hershon SJ. Shoulder motion and laxity in the professional baseball player. American Journal of Sports Medicine. 1997;25(5):609-613.
59. Noffal GJ. Isokinetic eccentric-to-concentric strength ratios of the shoulder rotator muscles in throwers and nonthrowers. American Journal of Sports Medicine. 2003;31(4):537-541.
60. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. American Journal of Sports Medicine. 2006;34(3):385-391.
61. Hebert LJ, Moffet H, McFadyen BJ, Dionne CE. Scapular behavior in shoulder impingement syndrome. Archives of Physical Medicine and Rehabilitation. 2002;83:60-69.
62. Endo K, Ikata T, Katoh S, Takeda Y. Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome. Journal of Orthopaedic Science. 2001;6:3-10.
63. Borstad JD, Ludewig PM. Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane. Clinical Biomechanics. 2002;17:650-659.
64. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Scapular position and orientation in throwing athletes. American Journal of Sports Medicine. 2005;33(2):263-271.
65. Borich MR, Bright JM, Lorello DJ, Cieminski CJ, Buisman T, Ludewig PM. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. Journal of Orthopaedic and Sports Physical Therapy. 2006;36(12):926-934.
66. Laudner KG, Myers JB, Pasquale MR, Bradley JP, Lephart SM. Scapular dysfunction in throwers with pathologic internal impingement. Journal of Orthopaedic and Sports Physical Therapy. 2006;36(7):485-494.
67. Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. American Journal of Physical Medicine and Rehabilitation. 1988;67(6):238-245.
68. Watson CJ, Schenkman M. Physical therapy management of isolated serratus anterior muscle paralysis. Physical Therapy. 1995;75(3):194-202.
69. Bagg SD, Forrest WJ. Electromyographic study of the scapular rotators during arm abduction in the scapular plane. American Journal of Physical Medicine. 1986;65(3):111-124.
70. Wadsworth D, Bullock-Saxton J. Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. International Journal of Sports Medicine 1997;18(8):618-624.
71. Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: Trapezius muscle latency with and without impingement symptoms. American Journal of Sports Medicine. 2003;31(4).
72. Moraes GFS, Faria CDCM, Teixeira-Salmela LF. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. Journal of Shoulder and Elbow Surgery. 2008;17:48S-53S.
73. Faria CDCdM, Teixeira-Salmela LF, Goulart FRdP, Moraes GFdS. Scapular muscular activity with shoulder impingement syndrome during lowering of the arms. Clinical Journal of Sport Medicine. 2008;18:130-136.
74. Kronberg M, Brostrom L-A, Nemeth G. Differences in shoulder muscle activity between patients with generalized joint laxity and normal controls. Clinical Orthopaedics and Related Research. 1991;269:181-192.
75. Kronberg M, Brostrom L-A. Electromyographic recordings in shoulder muscles during eccentric movements. clinical Orthopaedics and Related Research. 1995;314:143-151.
76. Cools AM, Witvrouw EE, Declercq GA, Vanderstraeten GG, Cambier DC. Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. British Journal of Sports Medicine. 2004;38:64-68.
77. Cools AM, Declercq GA, Cambier DC, Mahieu NN, Witvrouw EE. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian Journal of Medicine and Science in Sports. 2007;17:25-33.
78. Rotator Cuff Treatment: Subacromial abrasion. January 26, 2005. Available at: http://www.orthop.washington.edu/uw/rotatorcuff/tabID__3376/ItemID__203/PageID__409/Articles/Default.aspx.
79. Kernohan W, Beverland D, McCoy G, et al. The diagnostic potential of vibration arthrography. Clinical Orthopaedics and Related Research. 1986;210:106-112.
80. McCoy G, McCrea J, Beverland D, Kernohan W, Mollan R. Vibration arthrography as a diagnostic aid in diseases of the knee. Journal of Bone and Joint Surgery. 1987;69:288-293.
81. Norkin C, White D. Measurement of joint motion: A guide to geometry. 3rd ed. Philadelphia: FA Davis Company; 2003.
82. Kibler WB. The role of the scapula in athletic shoulder function. American Journal of Sports Medicine. 1998;26(2):325-337.
83. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641-661.
84. Cram JR, Kasman GS. Introduction to surface electromyography. Gaithersburg, Maryland: Aspen publisher, Inc.; 1998.
85. Hislop HJ, Montgomery J. Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination. 7th ed. Singapore: Elsevier; 2002.
86. Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: Reliability and construct validity. Physical Therapy. 2005;85(11):1128 –1138.
87. Ekstrom RA, Soderberg GL, Donatelli RA. Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis. Journal of Electromyography and Kinesiology. 2005;15:418-428.
88. Osbahr DC, Murrell GAC. The rotator cuff functional index. American Journal of Sports Medicine. 2006;34(6):956-960.
89. Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Archives of Physical Medicine and Rehabilitation. 1997;78(11):1215-1223.
90. Lewis JS, Valentine RE. The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musculoskeletal Disorders. 2007;8:64-73.
91. Meskers CGM, Vermeulen HM, Groot JHd, Helm FCTvd, Razing PM. 3D shoulder position measurements using a six-degree-of-freedom electromagnetic tracking device. Clinical Biomechanics. 1998;13:280-292.
92. Meskers CGM, Helm FCTvd, Rozendaal LA, Rozing PM. In vivo estimation of the glenohumeral joint rotation center from scapular bony landmarks by linear regression. Journal of Biomechanics. 1998;31:93-96.
93. Kuo T, Chen P, Chen W. Alterations of scapular muscle activation in asymptomatic persons with subacromial crepitus. International Society of Biomechanics XXIth Congress. Taipei, Taiwan; 2007.
94. Kendall F, McCreary E, Provance P. Muscles testing and function. Baltimore: Williams and Wilkins; 1993.
95. Borstad JD. Resting position variables at the shoulder: Evidence to support a posture-impairment association. Physical Therapy. 2006;86(4):549-557.
96. Cools AM, Witvrouw EE, Clercq GAD, 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 Therapy. 2002;32(5):221-229.
97. Lo Y, Hsu Y, Chan K. Epidemiology of shoulder impingement in upper arm sports events. British Journal of Sports Medicine. 1990;24(3):173-177.
98. Fahlstrom M, Yeap JS, Alfredson H, Soderman K. Shoulder pain – a common problem in world-class badminton players. Scandinavian Journal of Medicine and Science in Sports. 2006;16:168-173.
99. Fahlstrom M, Soderman K. Decreased shoulder function and pain common in recreational badminton players. Scandinavian Journal of Medicine and Science in Sports. 2007;17:246-251.
100. Sakurai S, Ohtsuki T. Muscle activity and accuracy of performance of the smash stroke in badminton with reference to skill and practice. Journal of Sports Sciences. 2000;18:901-914.
101. Ng GYF, Lam PCW. A study of antagonist/agonist isokinetic work ratios of shoulder rotators in men who play badminton. Journal of Orthopaedic and Sports Physical Therapy. 2002;32(8):399-404.
102. Kibler WB, Uhl TL, Maddux JWQ, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: A reliability study. Journal of Shoulder and Elbow Surgery. 2002;11(6):550-556.
103. Cools AM, Declercq G, Cagnie B, Cambier D, Witvrouw E. Internal impingement in the tennis player: rehabilitation guidelines. British Journal of Sports Medicine. 2008;42:165-171.
104. Lehman KR, Psihogios JP, Meulenbroek RGJ. Effects of sitting versus standing and scanner type on cashiers. Ergonomics. 2001;44(7):719-738.
105. Endo K, Yukata K, Yasui N. Influence of age on scapulo-thoracic orientation. Clinical Biomechanics. 2004;19:1009-1013.
106. Santos MJ, Belangero WD, Almeida GL. The effect of joint instability on latency and recruitment order of the shoulder muscles. Journal of Electromyography and Kinesiology. 2007;17(2):167-175.
107. Matias R, Pascoal AG. The unstable shoulder in arm elevation: A three-dimensional and electromyographic study in subjects with glenohumeral instability. Clinical Biomechanics. 2006;21(1S):52-58.
108. Warner JJP, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. American Journal of Sports Medicine. 1990;18(4):366-375.
109. MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. Journal of Shoulder and Elbow Surgery. 2004;13(6):593-598.
110. Kolber MJ, Beekhuizen K, Cheng M-SS, Fiebert IM. The reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal and external rotator musculature using a stabilization device. Physiotherapy Theory and Practice. 2007;23(2):119-124.
111. Gold G, Pappas G, Blemker S, et al. Abduction and external rotation in shoulder impingement: An open MR study on healthy volunteers--initial experience. Radiology. 2007;244(3):815-822.
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