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Several tools have been used to assess muscular stiffness. Myotonometry stands out as an accessible, handheld, and easy to use tool. The purpose of this review was to summarize the psychometric properties and methodological considerations of myotonometry and its applicability in assessing scapular muscles. Myotonometry seems to be a reliable method to assess several muscles stiffness, as trapezius. This method has been demonstrated fair to moderate correlation with passive stiffness measured by shear wave elastography for several muscles, as well as with level of muscle contraction, pinch and muscle strength, Action Research Arm Test score and muscle or subcutaneous thickness. Myotonometry can detect scapular muscles stiffness differences between pre- and post-intervention in painful conditions and, sometimes, between symptomatic and asymptomatic subjects.

Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14-16, and >16 years). Cross-sectional study. Tennis training sports facilities. Fifty-nine adolescent Swedish elite tennis players (ages 10-20 years) selected based on their national ranking. We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight-normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence.

Round-shoulder posture (RSP) is a common postural condition, characterized by protraction, downward rotation, anterior tilting and internal rotation of the scapula. RSP can lead to shoulder dysfunction. Different methods have been proposed for rehabilitating and correcting the altered posture in RSP including stretching, strengthening exercises, and shoulder brace or taping. However, the findings are controversial and studies are ongoing to develop more effective method. The present study is aimed at investigating the effects of scapular posterior tilting (SPT) exercise in different support positions on scapular muscle activities in men and women with RSP. In a prospective observational clinical study, we assessed demographic, basic clinical parameters and study variables of the subjects with RSP (n = 20) (men/women = 9/11) attending Daegu University in Gyeongsan, South Korea. To do so, we compared electromyographic (EMG) activities of lower trapezius and serratus anterior muscles between men and women with RSP during SPT exercise on four different support surfaces to determine any difference in the EMG activities. The results revealed that women showed significant differences in EMG activities in the lower and left upper trapezius and serratus anterior muscles, while men showed significant differences in EMG activity only in the lower trapezius muscle during SPT exercise on four different surfaces ( P  < 0.05). The post-hoc analysis revealed significantly greater EMG activity values in the lower trapezius and serratus anterior muscles during SPT exercise on the upper body unstable surface and whole-body unstable surface ( p  < 0.05). Independent t-tests after the Bonferroni correction showed no significant differences in muscle activities between men and women on the four different surfaces ( p  > 0.0125).

Background and Objectives: Scapular muscles are crucial in controlling scapular movement, ensuring proper alignment, and preventing injuries during shoulder joint motion. The shoulder abduction angle is one of the most important factors when performing exercises to improve scapular movement control. The Pilates reformer arm work (AW) movement can be performed with different shoulder abduction angles. Therefore, this study analyzed the differences in scapular muscle activation depending on the shoulder abduction angle during the AW movement. Materials and Methods: Twenty-six healthy adult males performed the AW movement under four shoulder abduction angle conditions (0°, 90°, 135°, 160°). When performing the AW in the four conditions, surface electromyography analyzed the muscle activation of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), serratus anterior (SA), posterior deltoid (PD), and levator scapulae (LS), and the muscle activation ratios of the UT/LT, LS/LT, UT/SA, and LS/SA. Results: The UT, LT, and SA muscle activation increased proportionally with the increasing shoulder abduction angle (p < 0.001). The LT showed the highest muscle activity at the shoulder abduction angle of 135° (p < 0.001). The MT and PD showed the highest muscle activities at the shoulder abduction angle of 90° (p < 0.001). The muscle activity ratios of the UT/LT and LS/LT were the lowest at the shoulder abduction angles of 90° and 135° (p < 0.001). The muscle activity ratio between the UT/SA and LS/SA was the lowest at the 135° and 160° shoulder abduction angles (p < 0.001). Conclusions: Our findings highlight the impact of the shoulder abduction angle on scapular muscle activation, suggesting that different angles may be used to engage specific muscles during Pilates reformer arm work exercises selectively. This insight can guide exercise interventions for individuals aiming to improve their scapular control and stability.

Introducción: La epicondilalgia lateral (EL) es una afección común causada por microtraumatismos debido a movimientos repetidos, afectando al 40% de la población en algún momento de su vida. La falta de éxito a largo plazo en el tratamiento de la EL puede estar relacionada con la subestimación de deficiencias de fuerza en las estructuras proximales al codo, contribuyendo a tensiones excesivas en el tendón extensor corto del carpo (TECC). Objetivo: El objetivo de este estudio fue evaluar si la combinación de un programa de ejercicio de fuerza en la región escapular (PEE) junto con un programa de ejercicio convencional (PEC) resultó en mejoras estadísticamente significativas en pacientes con EL. Metodología: Este ensayo clínico aleatorizado (ECA) incluyó 60 pacientes que se asignaron a 2 grupos de manera aleatoria. El grupo control (GC) recibió solo PEC, mientras que el grupo experimental (GE), además del PEC, implementó un PEE. Se evaluaron variables relacionadas con dolor, funcionalidad, umbral de dolor a la presión, fuerza prensil. Se llevaron a cabo 12 sesiones de 30 minutos cada una distribuidas en 3 sesiones por semana durante 4 semanas. Resultados: No se observaron diferencias significativas entre los dos grupos en cuanto al dolor (p = 0,104), la funcionalidad (p = 0,08), así como en el umbral de dolor a la presión (p = 0,999) o la fuerza prensil, ya sea con el brazo flexionado (p = 0,94) o en extensión (p = 0,70). Además, se encontró una interacción significativa entre el tiempo y el tratamiento (p = 0,046). Sin embargo, no se encontraron diferencias significativas en la intensidad del dolor entre los grupos (p = 0,788). Conclusiones: La combinación de ambos programas parece ser una herramienta terapéutica prometedora para el tratamiento de la EL. Sin embargo, no se ha podido afirmar que la realización de un PEE junto con un PEC sea superior en términos de efectividad a corto y medio plazo. Palabras clave: Epicondilalgia lateral (lateral epicondylalgia), Codo de tenista (tennis elbow), Epicondilitis lateral (lateral epicondylitis), Ejercicio (exercise), Musculatura escapular (scapular muscle). Abstract.  Lateral epicondylalgia (LE) is a common condition caused by microtrauma due to repeated movements, affecting the 40% of the population at some point in their lives. The lack of long-term success in the treatment of EL may be related to underestimation of strength deficiencies in structures proximal to the elbow, contributing to excessive stresses on the extensor carpi brevis tendon (ECC). Objective: The aim of this study was to evaluate whether the combination of a scapular strength exercise programme (SEP) in conjunction with a conventional exercise programme (CEP) resulted in statistically significant improvements in patients with EL. Methodology: This randomised clinical trial (RCT) included 60 patients who were randomly assigned to 2 groups. The control group (CG) received only the exercise program conventional (PEC) for the epicondylar muscles, while the group Experimental (GE), in addition to the PEC, implemented an exercise program of strength in the scapular region (SEP). Variables related to pain, functionality, threshold were evaluated for pressure, pain, grip strength and quality of life. There were 12 sessions of 30 minutes each distributed in 3 sessions per week for 4 weeks. Results: No significant differences were observed between the two groups in terms of pain (p = 0.104), functionality (p = 0.08), as well as pain threshold to pressure (p = 0.999) or prehensile strength, either with the arm flexed (p = 0.94) or in extension (p = 0.70). Conclusions: The combination of both programmes seems to be a promising therapeutic tool for the treatment of EL. However, it could not be affirmed that the implementation of a PEE together with a CEP is superior in terms of effectiveness in the short and medium term. Key Words: Lateral epicondylalgia, tennis elbow, lateral epicondylitis, exercise, scapular muscle.

Background: Improvements in motor control of the scapular muscles are important for the prevention and rehabilitation of shoulder and elbow injuries in overhead athletes. Purpose: To clarify scapular muscle activity during multijoint compound movement exercises using fine-wire and surface electrodes. Study Design: Descriptive laboratory study. Methods: Sixteen healthy men performed 5 types of exercises (cat and dog, trunk rotation, A-exercise, T-exercise, and Y-exercise). Muscle activity was measured as percentage of maximum voluntary isometric contraction (%MVIC) by using fine-wire electrodes in the rhomboid major (Rhom) and using surface electrodes in the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscles. The Rhom/UT, MT/UT, LT/UT, and SA/UT muscle activity ratios were calculated. One-way analysis of variance was used to compare the %MVIC and muscle activity ratios between exercises. Results: There was no significant difference in Rhom activity between the exercises (34.6-54.2%MVIC; P = .25). LT activity was significantly greater in the trunk rotation (58.0 ± 24.6%MVIC) and Y-exercise (63.2 ± 40.1%MVIC) than in the cat and dog scapular retraction (19.6 ± 9.3%MVIC) and A-exercise (28.2 ± 14.2%MVIC) (P < .05). SA activity was significantly greater in the cat and dog scapular protraction (26.7 ± 11.0%MVIC) and Y-exercise (25.6 ± 19.3%MVIC) than in the other exercises (P < .05). The SA/UT activity ratio in the cat and dog scapular protraction exercise (9.64 ± 8.48) was significantly higher than in the other exercises (P < .05). Conclusion: All the exercises were effective for activating the Rhom. The trunk rotation and Y-exercise were effective for activating the LT, and the cat and dog scapular protraction exercise was effective for activating the SA while suppressing the UT. Clinical Relevance: These results enable exercise selection based on muscle activity characteristics (moderate [20%-50%MVIC] and high [>50%MVIC] levels contribute to muscle activation) to prevent and rehabilitate shoulder and elbow injuries.

Playing tennis requires unilateral and intensive movement of the upper limb, which may lead to functional adaptations of the shoulder and an increased injury risk. Identifying which athletes will be future elite tennis players starts at 5 to 6 years of age. Therefore, highly skilled players practice intensively in their childhood. However, whether these functional changes occur during the prepubertal years has not been established. To assess changes in glenohumeral-joint-rotation range of motion and strength of the shoulder-complex muscles in prepubertal elite tennis players. Cross-sectional study. Tennis training sports facilities. Sixty-seven male tennis players (age range = 7-13 years) selected by a regional tennis center of excellence were divided into 3 biological age groups relative to their predicted age at peak height velocity: greater than 4 (n = 26; age = 8.7 ± 0.7 years, height = 132.4 ± 12.9 cm, mass = 27.8 ± 3.8 kg), 3 to 4 (n = 21; age = 10.3 ± 0.6 years, height = 144.9 ± 5.7 cm, mass = 34.7 ± 4.0 kg), and 2 (n = 20; age = 12.8 ± 1.4 years, height = 158.5 ± 8.7 cm, mass = 43.0 ± 8.2 kg) years before their age at peak height velocity. We measured the internal- and external-rotation ranges of motion of the glenohumeral joint using a goniometer and calculated the total arc of motion. Maximal isometric strength of 8 shoulder muscles was measured using a handheld dynamometer. Strength values were normalized to body weight and used to calculate 4 agonist-to-antagonist strength ratios. The total arc of motion of the glenohumeral joint decreased gradually with biological age (P ≤ .01) due to the decrease in internal-rotation range of motion (P < .001). Absolute strength increased gradually with biological age (P < .001), but the relative strengths and ratios remained similar. Functional adaptations of the shoulder seen in adolescent and adult tennis players were observed in healthy prepubertal players. This knowledge could help clinicians and coaches more effectively monitor shoulder adaptations to tennis practice during the prepubertal years.

To compare the reduction of subacromial space (SAS) during arm abduction between overhead athletes with and without rotator cuff (RC) tendinopathy, and to explore the relationship between the strength of scapular muscles with the SAS. Cross-sectional study. Sixty-six athletes (33 healthy and 33 with RC tendinopathy, mean age=22.3 years) participated in the study. Ultrasound measurement of the SAS with arm at 0°, 30° and 60° of shoulder abduction were taken, and the maximal isometric force in upper, middle and lower trapezius, and serratus anterior with manual muscle tests (MMT) were assessed using a handheld dynamometer. The change in SAS during arm abduction from 0° to 30° (SAS0°–30°), 30° to 60° (SAS30°–60°) and 0° to 60° (SAS0°–60°) was compared between groups. Differences in force produced with scapular muscles MMT between groups and relationships with reduction in SAS were explored. We found more reduction of the SAS during SAS0°–30° in athletes with RC tendinopathy (0.44±1.22mm) than healthy athletes (−0.06±1.41mm) (p=0.045). Athletes with RC tendinopathy demonstrated significant decrease in all scapular muscles MMT strength when compared to their healthy counterparts (p<0.05). In healthy athletes, a lower middle and lower trapezius MMT strength were moderately associated with a greater reduction in SAS during 0° to 30° (r=−0.445, p=0.016 and r=−0.423, p=0.022, respectively) and 0° to 60° of shoulder abduction (r=−0.415, p=0.018 and r=−0.504, p=0.003, respectively). Athletes with RC tendinopathy demonstrated more reduction in the SAS during early arm abduction. Decreased strength of middle and lower trapezius was related to reduction of the SAS.

Lateral epicondylalgia (LE) is a common condition caused by microtrauma due to repeated movements, affecting the 40% of the population at some point in their lives. The lack of long-term success in the treatment of EL may be related to underestimation of strength deficiencies in structures proximal to the elbow, contributing to excessive stresses on the extensor carpi brevis tendon (ECC). Objective: The aim of this study was to evaluate whether the combination of a scapular strength exercise programme (SEP) in conjunction with a conventional exercise programme (CEP) resulted in statistically significant improvements in patients with EL. Methodology: This randomised clinical trial (RCT) included 60 patients who were randomly assigned to 2 groups. The control group (CG) received only the exercise program conventional (PEC) for the epicondylar muscles, while the group Experimental (GE), in addition to the PEC, implemented an exercise program of strength in the scapular region (SEP). Variables related to pain, functionality, threshold were evaluated for pressure, pain, grip strength and quality of life. There were 12 sessions of 30 minutes each distributed in 3 sessions per week for 4 weeks. Results: No significant differences were observed between the two groups in terms of pain (p = 0.104), functionality (p = 0.08), as well as pain threshold to pressure (p = 0.999) or prehensile strength, either with the arm flexed (p = 0.94) or in extension (p = 0.70). Conclusions: The combination of both programmes seems to be a promising therapeutic tool for the treatment of EL. However, it could not be affirmed that the implementation of a PEE together with a CEP is superior in terms of effectiveness in the short and medium term. Introducción: La epicondilalgia lateral (EL) es una afección común causada por microtraumatismos debido a movimientos repetidos, afectando al 40% de la población en algún momento de su vida. La falta de éxito a largo plazo en el tratamiento de la EL puede estar relacionada con la subestimación de deficiencias de fuerza en las estructuras proximales al codo, contribuyendo a tensiones excesivas en el tendón extensor corto del carpo (TECC). Objetivo: El objetivo de este estudio fue evaluar si la combinación de un programa de ejercicio de fuerza en la región escapular (PEE) junto con un programa de ejercicio convencional (PEC) resultó en mejoras estadísticamente significativas en pacientes con EL. Metodología: Este ensayo clínico aleatorizado (ECA) incluyó 60 pacientes que se asignaron a 2 grupos de manera aleatoria. El grupo control (GC) recibió solo PEC, mientras que el grupo experimental (GE), además del PEC, implementó un PEE. Se evaluaron variables relacionadas con dolor, funcionalidad, umbral de dolor a la presión, fuerza prensil. Se llevaron a cabo 12 sesiones de 30 minutos cada una distribuidas en 3 sesiones por semana durante 4 semanas. Resultados: No se observaron diferencias significativas entre los dos grupos en cuanto al dolor (p = 0,104), la funcionalidad (p = 0,08), así como en el umbral de dolor a la presión (p = 0,999) o la fuerza prensil, ya sea con el brazo flexionado (p = 0,94) o en extensión (p = 0,70). Además, se encontró una interacción significativa entre el tiempo y el tratamiento (p = 0,046). Sin embargo, no se encontraron diferencias significativas en la intensidad del dolor entre los grupos (p = 0,788). Conclusiones: La combinación de ambos programas parece ser una herramienta terapéutica prometedora para el tratamiento de la EL. Sin embargo, no se ha podido afirmar que la realización de un PEE junto con un PEC sea superior en términos de efectividad a corto y medio plazo.

To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain.