[ RESEARCH REPORT ]
PETER J. RUNDQUIST, PT, PhD1
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Alterations in Scapular Kinematics
in Subjects With Idiopathic Loss of
Shoulder Range of Motion
diopathic loss of shoulder range of motion (ROM) is
I a description used to identify subjects that present
with decreased shoulder mobility of unknown etiology. 7
The condition affects 3% of the population. 32 Despite
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
several authors’ reports that the condition spontaneously
resolves within 2 years, 7,13 subjects continue to report
shoulder pain, stiffness, or both for up to 7 years. 41
Etiologic investigations have focused
primarily on the glenohumeral joint. Pro-
posed etiologies include decreased capsu-
lar volume,20,33 degenerative changes,2,47
Journal of Orthopaedic & Sports Physical Therapy®
 STUDY DESIGN: Prospective cohort study.
 OBJECTIVE: To determine the effect of
idiopathic loss of shoulder range of motion on
scapular kinematics.
 BACKGROUND: Subjects with idiopathic
loss of shoulder range of motion have difficulty
performing activities of daily living. Previous
investigations have focused on the glenohumeral
component of shoulder complex motion.
 MATERIALS AND METHODS: Seventeen
unilaterally impaired and 17 nonimpaired sub-
jects. The 3-dimensional motion of the humerus,
scapula, and trunk were measured with the Fas-
trak electromagnetic motion-tracking system
during humerus-to-trunk scapular plane eleva-
tion. An analysis of variance compared the im-
paired subjects noninvolved to the nonimpaired
subjects’ scapulae at 4 scapular plane elevation
positions. A repeated-measures analysis of vari-
ance compared the impaired subjects’ involved
and noninvolved scapulae at 3 scapular plane
elevation positions, and matched-pairs t test
compared peak elevation values.
1
Assistant Professor, Doctor of Physical Therapy Program, University of Indianapolis, Krannert School of Physical Therapy, Indianapolis, IN. The protocol for this study was
approved by the University of Minnesota Institutional Review Board. Address correspondence to Peter J. Rundquist, University of Indianapolis, Krannert School of Physical
Therapy, 1400 East Hanna Avenue, Indianapolis, IN 46227. E-mail: prundquist@uindy.edu
journal of orthopaedic & sports physical therapy | volume 37 | number 1 | january 2007 |
JOSJan07_RundquistV5.indd 19
shoulder capsule adhesions,1,30,31 syno-
vitis,14,46,47 and thickened synovium.11,24
These etiologic investigations have led
to multiple alternative labels proposed
 RESULTS: The between-group ANOVAs
demonstrated no difference in anterior tipping,
internal rotation, or upward rotation. The re-
peated-measures ANOVAs demonstrated no dif-
ference in anterior tipping or internal rotation and
a position-by-side interaction in upward rotation.
The involved-side scapulae were more upwardly
rotated (7.7°) at peak humerus-to-trunk scapular
plane elevation.
 DISCUSSION AND CONCLUSION: The
impaired subjects’ noninvolved scapular kine-
matics were not significantly different than the
nonimpaired subjects, but were significantly
different than their involved scapulae. The up-
ward rotation differences may be a substitution
pattern used to accomplish functional elevation.
J Orthop Sports Phys Ther 2007;37(1):19-25.
doi:10.2519/jospt.2007.2121
 KEY WORDS: biomechanics, motion analy-
sis, scapula, upper extremity
in the literature. The most frequently
cited are adhesive capsulitis and frozen
shoulder. These labels are essentially
interchangeable with idiopathic loss of
shoulder ROM.
Subjects with idiopathic loss of shoul-
der ROM consistently report decreased
motion in multiple planes.7,15,41 Frequent
functional complaints include difficulty
getting dressed, completing personal hy-
giene,29 and performing tasks requiring
overhead reaching.15 Performance of these
activities of daily living requires the com-
bined and coordinated motions of the
scapulothoracic and glenohumeral joints.
The scapula links the humerus to the
trunk. Scapulothoracic motion is neces-
sary to achieve full humerus-to-trunk
scapular plane elevation. Cathcart6 was
the first to recognize the scapulothoracic
contribution to normal shoulder com-
plex kinematics. He determined that the
scapula moved on the thorax throughout
humerus elevation. Many terms have been
utilized to describe the movement of the
scapula on the thorax. For consistency,
this article will use terminology presented
by Ludewig et al.22 Upward/downward
rotation occurs around an axis perpen-
dicular to the plane of the scapula. Pos-
terior/anterior tipping occurs around an
axis approximately parallel to the spine
of the scapula. Internal/external rotation
occurs around a vertical axis.
Scapular motion on the thorax dur-
19
12/20/06 5:54:50 PM

ing humerus-to-trunk scapular plane
elevation has been evaluated through 2-
dimensional (2-D) and 3-dimensional (3-
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D) investigations. Although the subjects’
demographics and investigation meth-
odologies differed, the results have been
fairly consistent. The initial examination
of scapular motion utilized 2-D radio-
graphs to determine the scapula upwardly
rotates and posteriorly tips throughout
scapular plane elevation.36
Three-D analyses have confirmed that
the scapula progressively upwardly ro-
tates.8,10,16,21-23,25,26,43 The majority of the
cited studies also found that the scapula
progresses from an anterior- to a pos-
terior-tipped orientation.8,16,21-23,25,26,43
However, Ebaugh et al10 described ante-
rior scapular tipping above 90° elevation.
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Scapular external/internal rotation find-
ings have been the most variable. Several
authors have reported that the scapula
progressively externally rotates.16,22,25,26,43
The authors of one study reported scapu-
lar internal rotation does not change.21
The authors of another study reported
the scapula externally rotates as eleva-
tion progresses from rest to horizontal
Journal of Orthopaedic & Sports Physical Therapy®
and remains relatively stable as elevation
progresses beyond the horizontal in the
asymptomatic shoulder in subjects with
impingement syndrome.23 Finally, the
authors of 2 studies reported progressive
internal rotation.8,10
To this date, there has been no inves-
tigation of the scapulothoracic movement
in subjects with idiopathic loss of shoul-
der ROM. The purposes of the current
study were to quantitatively compare the
scapulothoracic kinematics of individuals
with unilateral idiopathic loss of shoulder
TABLE 1
IMPAIRED
Age (y) 52.4 ⫾ 6.5 (40.0-65.0)
Height (m) 1.7 ⫾ 0.1 (1.6-1.8)
Body mass (kg) 70.5 ⫾ 10.0 (56.8-95.5)
Symptom duration (mo) 7.5 ⫾ 4.0 (2-14)
* Each group consisted of 16 females and 1 male; values expressed as mean ⫾ SD (range).
20 | january 2007 | volume 37 | number 1 | journal of orthopaedic & sports physical therapy
JOSJan07_RundquistV5.indd 20
[ RESEARCH REPORT
ROM to nonimpaired subjects’ scapulae
utilizing 3-D analysis. The first hypoth-
esis was that the impaired subjects’ non-
involved-side scapular kinematics would
not be significantly different than the
nonimpaired subjects’ shoulder kinemat-
ics, validating side-to-side comparisons.
The second hypothesis was that the im-
paired subjects’ involved-side scapular ki-
nematics would be significantly different
than the kinematics of the noninvolved
side. It was assumed that involved-side
scapular motions may be less as an indi-
cation of overall shoulder complex ROM
loss, or may be greater to compensate for
glenohumeral motion losses.
METHODS
Subjects
T
his study was based on data col-
lected during a comprehensive in-
vestigation of subjects with idiopath-
ic loss of shoulder ROM and function.38
Seventeen volunteers with a unilaterally
involved shoulder and 17 nonimpaired
volunteers were evaluated. Impaired vol-
unteers were recruited from local ortho-
pedic surgeons, physical therapy clinics,
and through contacts generated by an
article published in the local newspaper.
Nonimpaired volunteers were recruited
throughout the local community. Based on
the investigator’s clinical evaluation, all of
the impaired subjects presented with signs
and symptoms consistent with idiopathic
loss of shoulder ROM.
The demographic data were normally
distributed. The nonimpaired and im-
paired subjects’ age, height, and body
mass were compared using independent
Demographic Data*
NONIMPAIRED t VALUE P VALUE
51.1 ⫾ 7.6 (37.0-64.0) 0.512 .61
1.7 ⫾ 0.1 (1.5-1.8) –0.517 .57
71.2 ⫾ 13.8 (49.1-81.8) –0.162 .87
]
sample t tests. There were no statis-
tically significant differences between
the groups. TABLE 1 outlines the demo-
graphic data. The groups were matched
based on equal gender distribution and
the impaired subjects’ hand dominance
and involved side. Dominant side was
based on subject handedness report.
There were 15 right-hand-dominant and
2 left-hand-dominant subjects in each
group. The distribution of impaired sub-
jects’ involved side and the nonimpaired
subjects’ evaluated side is outlined in
TABLE 2.
The University of Minnesota Institu-
tional Review Board approved the inves-
tigation. All subjects read and signed an
informed-consent form prior to participa-
tion in the study. All subjects were at least
18 years old. The subjects’ rights were
protected. To be included, subjects had
symptoms for at least 1 month without
exacerbation over the previous month.
Additionally, they had goniometrically
measured passive ROM losses of at least
25% compared to their noninvolved
shoulder in at least 2 of the following
shoulder motions relative to the trunk:
abduction, external rotation, and/or in-
ternal rotation.
Exclusion criteria, based on a cervical
and shoulder evaluation, were any identi-
fiable etiology for the ROM loss. A history
of any shoulder or systemic condition that
would have residual effects on shoulder
ROM led to exclusion as well. The specific
exclusion criteria have been published
previously.39,40
Instrumentation
The 3-D kinematics of each subject’s hu-
merus, scapula, and thorax were evaluated
with the Polhemus FASTRAK electro-
magnetic motion capture system (Polhe-
mus, Inc, Colchester, VT). According to
the manufacturer, the root-mean-square
accuracy of the system is 0.15° for orienta-
tion and 0.3 to 0.8 mm for position.35
Experimental Procedure
Data collection was performed at 40 Hz,
as outlined in previous investigations.39,40
12/20/06 5:54:51 PM

TABLE 2 Distribution of Involved and Evaluated Side
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SIDE
IMPAIRED SUBJECTS
R dominant/R involved
R dominant/L involved
L dominant/R involved
NONIMPAIRED SUBJECTS
R dominant/L evaluated
R dominant/R evaluated
L dominant/L evaluated
Abbreviations: L, left; R, right.
One FASTRAK sensor was attached to
the sternum, 1 to the flat superior bony
surface of the acromion process, and 1 was
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
secured to the distal humerus with Velcro
straps. FIGURE 1 illustrates the subjects’
experimental setup.
Data collection was performed while
the subjects were standing. Digitization
of bony landmarks on the thorax, scapula,
and humerus allowed for transformation
of sensor-based data to local anatomically
based coordinate systems.21
Journal of Orthopaedic & Sports Physical Therapy®
Scapular kinematic data were collected
for each subject’s full active humerus-to-
trunk scapular plane elevation ROM. The
scapular plane was defined as 40° anterior
to the coronal plane.21 The scapular plane
was marked with tape on the floor. A
SCAPULA SENSOR
TRUNK
SENSOR
TRANSMITTER
HUMERUS SENSOR
FIGURE 1. Experimental setup.
journal of orthopaedic & sports physical therapy | volume 37 | number 1 | january 2007 |
JOSJan07_RundquistV4.indd 21
n
5 rotation, and anterior tipping values
10
2 data point as close to without exceeding
5
10
2 subjects’ noninvolved and nonimpaired
vertical plywood guide was used to keep
the subject’s arm in the scapular plane.
The subjects maintained light fingertip
contact on the board during the data col-
lection.
For the impaired subjects, data from
the noninvolved shoulder were collected
first to allow for procedure familiarity.
Subjects moved their arm as far as they
were able at a self-selected slow steady
speed. Five repetitions were collected for
each scapula. The average of the available
trials for each subject was used for data
analysis.
Data Reduction
Data reduction was performed as out-
lined in previous investigations.39,40 The
digitized anatomical points were used to
develop clinically relevant local anatomi-
cal coordinate systems.21,39 Matrix trans-
formations allowed for description of the
humerus in relation to the scapula and
thorax and the scapula in relation to the
thorax.21
Humerus orientation relative to the
thorax was described as rotation about zh
(orients the humerus in a plane of eleva-
tion), rotation about y'h (elevation angle),
and rotation about z"h (long-axis rotation)
(z, y', z" Euler angles). Scapula orienta-
tion relative to the thorax was described
as rotation about zs (internal/external
rotation), rotation about y's (downward/
upward rotation), and rotation about
x"s (posterior/anterior tipping) (z, y', x"
Cardan angles, FIGURE 2.) The rotation
sequences allowed for clinically relevant
descriptions of humerus and scapula mo-
tion and are consistent with those previ-
ously published.21
Scapular internal rotation, upward
were extracted from the data files at the
30°, 60°, and 90° of humerus-to-trunk
scapular plane elevation for all subjects.
Scapular positions at 120° scapular plane
elevation were extracted for the impaired
subjects’ scapulae. As the involved-side
shoulder elevation at peak was generally
less than 120° and variable between sub-
jects, scapular positions at peak scapular
plane elevation were extracted for im-
paired subjects’ involved scapulae, and
noninvolved-side data were extracted at
an elevation angle matched to the peak
for the involved side.
Data Analysis
An independent-samples t test was per-
formed to compare the peak humeral
elevation during scapular plane elevation
between the impaired subjects’ nonin-
volved shoulders and the side-matched
nonimpaired subjects’ shoulders. A
ZS, IR/ER
YS, UR/DR
XS, PT/AT
FIGURE 2. Scapular axes. Xs, PT/AT: scapula x-axis,
posterior and anterior tipping; Ys, UR/DR: scapula
y-axis, upward and downward rotation; Zs, IR/ER:
scapula z-axis, internal and external rotation.
21
12/17/06 7:36:40 PM

70
60
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SCAPULAR ANGLE (DEG)
50
40
30
20
10
0
30 60
HUMEROTHORACIC SCAPULAR PLANE ELEVATION (DEG)
NONINVOLVED
FIGURE 3. Scapular internal rotation: impaired
subjects’ noninvolved versus nonimpaired group
scapulae. Data are mean ⫾ SD. No statistically
significant differences (P>.05).
matched pairs t test was performed to
compare the peak humeral elevation dur-
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ing scapular plane elevation between the
impaired subjects’ involved and nonin-
volved shoulders.
For the 3 scapular variables, the exper-
imental design utilized 2-factor analyses
of variance (ANOVAs) to compare the im-
paired subjects’ noninvolved scapulae to
the nonimpaired subjects’ scapulae. These
analyses were completed to determine if
Journal of Orthopaedic & Sports Physical Therapy®
there was evidence that the noninvolved
side demonstrated abnormal shoulder
ROM or abnormal scapular motion. If
such deviations were present, they would
confound interpretation of side-to-side
comparisons for impaired subjects. Two-
factor repeated-measures ANOVAs were
used to compare the impaired subjects’
involved to the noninvolved scapulae. One
60
50
SCAPULAR ANGLE (DEG)
40
30
20
10
0
30 60
HUMEROTHORACIC SCAPULAR PLANE ELEVATION (DEG)
NONINVOLVED
FIGURE 4. Scapular upward rotation: impaired
subjects’ noninvolved versus nonimpaired group
scapulae. Data are mean ⫾ SD. No statistically
significant differences (P>.05).
22 | january 2007 | volume 37 | number 1 | journal of orthopaedic & sports physical therapy
JOSJan07_RundquistV5.indd 22
[ RESEARCH REPORT
set of analyses was performed for each
dependent variable (scapular internal
rotation, upward rotation, and anterior
tipping). The ANOVAs had a group fac-
tor (impaired or nonimpaired) and a hu-
merus-to-trunk scapular plane elevation
position factor (30°, 60°, 90°, 120°). The
repeated-measures ANOVAs had a side
factor (involved or noninvolved shoulder)
90 120 and a humerus-to-trunk scapular plane
elevation position factor (30°, 60°, 90°).
NONIMPAIRED
As peak elevation angles for the involved
shoulder were highly variable among sub-
jects, these scapular analyses were com-
pleted using matched pairs t tests. Peak
elevation angle values were matched to
extracted scapular values at the same hu-
meral elevation angle for the noninvolved
side because elevation angle is a major
determinant affecting scapular angles.
RESULTS
T
here was no significant differ-
ence in peak scapular plane elevation
ROM between the impaired subjects’
noninvolved shoulders (range, 136.8°-
168.6°; mean ⫾ SD, 153. 1° ⫾ 8.1°) and the
side- and gender-matched nonimpaired
subjects’ shoulders (range, 139.0°-177.6°;
mean ⫾ SD, 152.3° ⫾ 9.7°) (mean differ-
ence, 0.8°; independent samples t, .25; P
= .80). However, the involved shoulder
had significantly less peak scapular plane
elevation (range, 62.9°-147.6°; mean
⫾ SD, 117.6° ⫾ 19.7°) than the nonin-
volved shoulders (mean difference, 35.5°;
matched pairs t, 8.40; P<.01).
For between-group analyses of vari-
ance, there were no significant position-
by-group interactions or main effects for
any of the 3 scapular variables. On av-
erage, both the impaired subjects’ non-
involved scapulae and the nonimpaired
subjects’ scapulae minimally internally ro-
90 120 tated, progressively upwardly rotated, and
NONIMPAIRED
progressively anteriorly tipped through-
out humerothoracic scapular plane eleva-
tion (FIGURES 3-5).
For side-to-side comparisons, for the
group with unilateral idiopathic shoul-
der ROM loss, there were no significant
]
position-by-group interactions or main
effects for scapular internal rotation and
anterior tipping. There was a significant
interaction between position and side
for scapular upward rotation (F = 5.18,
P<.05). The involved scapulae were more
upwardly rotated at 90°. On average, both
the impaired subjects’ noninvolved scapu-
lae and their impaired scapulae minimally
internally rotated, progressively upward-
ly rotated, and progressively anteriorly
tipped throughout humerothoracic scapu-
lar plane elevation (FIGURES 6-8).
35
30
SCAPULAR ANGLE (DEG)
25
20
15
10
5
0
30 60 90 120
HUMEROTHORACIC SCAPULAR PLANE ELEVATION (DEG)
NONINVOLVED NONIMPAIRED
FIGURE 5. Scapular anterior tipping: impaired
subjects’ noninvolved versus nonimpaired group
scapulae. Data are mean ⫾ SD. No statistically
significant differences (P>.05).
The results of the matched pairs t tests
demonstrated that the involved scapulae
were significantly more upwardly rotated
(7.7°, P<.01) than the noninvolved scapu-
lae at peak involved-side scapular plane
elevation (TABLE 3).
DISCUSSION
T
he primary purpose of this inves-
tigation was to determine if there
were differences in the kinematics
of the involved and noninvolved scapulae
of subjects unilaterally impaired with id-
iopathic loss of shoulder ROM. The first
hypothesis was supported. The impaired
subjects’ noninvolved shoulder scapular
kinematics were not significantly differ-
ent than the scapular kinematics of the
nonimpaired subjects’ shoulders, validat-
ing side-to-side comparisons within the
impaired group. The second hypothesis
12/20/06 5:54:53 PM
 was also supported. From the repeated- One reason the subjects’ scapular tip-
60
measures analyses of upward rotation ping kinematics were different than those
50
within the group of subjects with unilat- commonly reported in the previous lit-

SCAPULAR ANGLE (DEG)

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eral idiopathic loss of shoulder ROM, it 40 erature may be gender distribution. In

was apparent that there were differences
between sides as scapular plane elevation
progressed with a significant side-by-posi-
tion interaction. The comparisons of the
scapular kinematic data matched for the
peak humeral elevation obtained on the
involved side are of most interest with re-
gard to possible scapular substitution. The
impaired subjects’ involved scapulae were
significantly more upwardly rotated (7.7°)
at peak scapular plane elevation than their
noninvolved scapulae. The upward rota-
tion findings may be attributed to scapu-
lothoracic compensation to overcome
glenohumeral loss of motion to allow for
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
30 the current study, 16 of 17 subjects were
20
female (94.1%). This is a higher percent-
age than any of the previous studies inves-
10
tigating scapular kinematics.10,16,21-23,25,26,43
0
30 60 90 Females more often present with idio-
HUMEROTHORACIC SCAPULAR PLANE ELEVATION (DEG)
pathic loss of shoulder ROM. Percentages
NONINVOLVED INVOLVED
have been reported as high as 84%.37 It
FIGURE 6. Scapular internal rotation from 30° to
may be that normal female scapular kine-
90° (16 subjects): impaired subjects’ involved versus matics are different than those of males.
noninvolved scapulae. Data are mean ⫾ SD. No Interestingly, the other previous study
statistically significant differences (P>.05). with similar anterior-tipping patterns in
healthy subjects10 was 1 of the few with
rotator cuff clearance during elevation of an equal gender distribution. This is an
the arm. avenue for further investigation.
The current subjects’ average scapu- A second reason the current results

completion of activities of daily living. This
difference between sides represents a large
portion of the available normal motion. In
the current study, the average impaired
subjects’ noninvolved scapular upward ro-
tation excursion was 32.8°. Consequently,
the 7.7° difference between sides is 23% of
the total motion.
The majority of kinematics-based
Journal of Orthopaedic & Sports Physical Therapy®
lar internal/external rotation data add were different than those previously re-
to the variety of patterns cited in the ported may be age. The mean age of the
literature, where this scapular variable is nonimpaired subjects in the current study
the least consistent across subjects and was 50.3 years and the oldest was 64 years.
investigations.8,10,16,22,23,25,26,43 Subjects in The mean age of the participants was
both groups showed small magnitudes of higher than that of participants in all of
progressively increasing scapular internal the previous investigations.8,10,16,21-23,25,26,43
rotation as humeral elevation progressed. The oldest subject is older than the oldest
The consensus from previous 3-D scapu- subject in all but 2 of the previous investi-

treatment investigations of subjects with
idiopathic loss of shoulder ROM have
focused on the glenohumeral joint.5,34,44,45
Interventions to encourage the alterations
in upward rotation in subjects with idio-
pathic loss of shoulder ROM may prove
to be functionally beneficial in the short
term to gain overall shoulder elevation
ROM relative to the trunk. However, the
long-term implications of these altered
scapular kinematics are uncertain. From
a physiological perspective, in addition to
maximizing ROM, increased scapular up-
ward rotation would seem to be protective
with regard to maximizing the subacromi-
al space and reducing risk for subacromial
impingement.12,21 However, in a cadaveric
analysis, Karduna et al17 were not able to
support a premise of increased clearance
for humeral head superior translations in
positions of increased scapular upward
rotation. Further study is needed with
regard to how scapular kinematic altera-
tions impact the subacromial space and
lar kinematics literature is that the normal
scapula progressively upwardly rotates
throughout humerus-to-trunk scapular
plane elevation.10,16,21-23,25,26,43 All of the
current subjects’ scapulae progressively
upwardly rotated as humeral elevation
progressed. The current subjects’ average
tipping results (progressive anterior tip-
ping) are contrary to the majority of stud-
ies in the literature which demonstrate
posterior tipping as the humerus elevates.
However, these tipping results are similar
to those reported by Ebaugh et al.10
TABLE 3
MOTION
Internal rotation
Upward rotation
Anterior tipping
* Humeral elevation angles were matched between sides. Values expressed as mean ⫾ SD (range).
gations. Lukasiewicz et al23 had a 66-year-
old subject and Ludewig and Cook21 had
a 71-year-old subject. The scapular kine-
matics found in the current investigation
may be a reflection of the aging process.
Two studies have been performed to com-
pare scapular motion across ages. Endo et
al,10 using radiographs, determined that
age was negatively correlated with upward
rotation and posterior tipping. Dayanidhi
et al8 utilized 3-D electromagnetic sensors
to determine that younger subjects had
more scapular upward rotation than older
Involved and Noninvolved Scapular
Position Based on the Maximum Elevation
Achieved on the Involved Side*
INVOLVED NONINVOLVED t VALUE P VALUE
45.1 ⫾ 13.2 (26.0-73.1) 48.2 ⫾ 13.6 (30.0-81.8) –0.802 .434
52.9 ⫾ 9.9 (37.4-69.9) 45.2 ⫾ 9.9 (26.3-66.3) –3.194 .006
23.1 ⫾ 14.6 (5.6-53.9) 16.9 ⫾ 15.2 (-2.3-65.9) –1.797 .091

journal of orthopaedic & sports physical therapy | volume 37 | number 1 | january 2007 | 23

JOSJan07_RundquistV4.indd 23 12/17/06 7:36:45 PM


subjects. The current results with lack of
scapular posterior tipping in both groups
may be related to the age of the subjects.
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The upward rotation differences between
sides are more likely due to glenohumeral
ROM loss compensation than to age, as
age is not a confounder to side-to-side
comparisons. This is an additional area
for further investigation.
The primary limitation of this study
is its small sample size. Differences may
exist between the groups that were not
found secondary to low statistical power.
Increasing the number of subjects may
allow for a better understanding of the
differences between the impaired sub-
jects’ involved and noninvolved and non-
impaired scapular kinematics. However,
the limited frequency of this diagnosis in
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
the general population is a practical con-
straint to a large sample size. The effect
size for the scapular internal rotation and
anterior tipping comparisons between
scapulae of the impaired subjects’ were
small (.17 and .18, respectively). The effect
sizes for the internal and upward rota-
tion and anterior tipping comparisons be-
tween the impaired subjects’ noninvolved
Journal of Orthopaedic & Sports Physical Therapy®
scapulae and the nonimpaired subjects’
50
45
40
35
SCAPULAR ANGLE (DEG)
30
25
20
15
10
5 Scapular kinematics during humeral elevation in
0
30 60
HUMEROTHORACIC SCAPULAR PLANE ELEVATION (DEG)
NONINVOLVED
FIGURE 7. Scapular upward rotation from 30°
to 90° (16 subjects): impaired subjects’ involved
versus noninvolved scapulae. Data are mean ⫾ SD.
Significant position-by-side interaction (P<.05). No
significant simple effects between sides were found
utilizing pairwise comparisons.
24 | january 2007 | volume 37 | number 1 | journal of orthopaedic & sports physical therapy
JOSJan07_RundquistV5.indd 24
[ RESEARCH REPORT
30
25
SCAPULAR ANGLE (DEG)
20
15
10
5
0
30
HUMEROTHORACIC SCAPULAR PLANE ELEVATION (DEG)
NONINVOLVED
FIGURE 8. Averaged scapular anterior tipping from
30° to 90° (16 subjects): impaired subjects’ involved
versus noninvolved scapulae. Data are mean ⫾ SD.
No statistically significant differences (P>.05).
scapulae were negligible (.021, .024, and
.004, respectively). To find a statistical
difference for any of these low-effect-size
comparisons would take more subjects
than were feasible to recruit.
Bony prominences were utilized for
sensor application. This was done to mini-
mize data collection errors secondary to
the sensor moving on the skin. Skin slip
still may have occurred during data collec-
tion. Karduna et al18 have demonstrated
sensor-based data collection is similar to
bone pin receivers at less than or equal to
120° elevation. Skin slip should not have
been a large source of error.
Velocity of shoulder elevation was not
controlled or measured in this investiga-
tion. It may be that differences in velocity
may have affected the results. However,
2 previous investigations on the effect of
velocity on scapular kinematics found that
changes in velocity did not significantly
affect the results.9,27
CONCLUSION
S
90
ubjects with idiopathic loss of
shoulder ROM have difficulty per-
INVOLVED forming activities of daily living. The
majority of the previous investigations re-
garding this condition have focused on
the glenohumeral component of shoulder
function. The results of the current investi-
gation support further investigation of the
scapulothoracic component. The impaired
subjects’ involved scapulae were more up-
]
wardly rotated at peak scapular plane el-
evation than their uninvolved side when
matched for humeral elevation angle. The
upward rotation results support a theory of
scapular compensation for loss of glenohu-
meral ROM to achieve greater humerus to
trunk scapular plane elevation. Both treat-
ment of glenohumeral ROM deficits and
60 90 the consequences of scapular substitution
may be avenues for potential intervention
INVOLVED necessitating further research.
ACKNOWLEDGEMENTS
I would like to acknowledge Clyde
B. Killian, PT, PhD for his statistics
consultation. 
REFERENCES
1. Bennett WF. Addressing glenohumeral stiffness
while treating the painful and stiff shoulder
arthroscopically. Arthroscopy. 2000;16:142-150.
2. Binder AI, Bulgen DY, Hazleman BL, Tudor J,
Wraight P. Frozen shoulder: an arthrographic and
radionuclear scan assessment. Ann Rheum Dis.
1984;43:365-369.
3. Boone DC, Azen SP, Lin CM, Spence C, Baron C,
Lee L. Reliability of goniometric measurements.
Phys Ther. 1978;58:1355-1390.
4. Borstad JD, Ludewig PM. Comparison of scapular
kinematics between elevation and lowering of the
arm in the scapular plane. Clin Biomech (Bristol,
Avon). 2002;17:650-659.
5. Boyles RE, Flynn TW, Whitman JM. Manipulation
following regional interscalene anesthetic block for
shoulder adhesive capsulitis: a case series. Man
Ther. 2005;10:164-171.
6. Cathcart CW. Movements of the shoulder girdle
involved in those of the arm on the trunk. J Anat
Physiol. 1884;18:211-218.
7. Codman EA. Rupture of the Supraspinatus Tendon
and Other Lesions in or about the Subacromial
Bursa. Boston, MA: Thomas Todd; 1934.
8. Dayanidhi S, Orlin M, Kozin S, Duff S, Karduna A.
adults and children. Clin Biomech (Bristol, Avon).
2005;20:600-606.
9. de Groot JH, Valstar ER, Arwert HJ. Velocity effects
on the scapulo-humeral rhythm. Clin Biomech
(Bristol, Avon). 1998;13:593-602.
10. Ebaugh DD, McClure PW, Karduna AR. Three-
dimensional scapulothoracic motion during
active and passive arm elevation. Clin Biomech
(Bristol, Avon). 2005;20:700-709.
11. Emig EW, Schweitzer ME, Karasick D, Lubowitz J.
Adhesive capsulitis of the shoulder: MR diagnosis.
Am J Roentgenol. 1995;164:1457-1459.
12/20/06 5:54:58 PM
 12. Endo K, Yukata K, Yasui N. Influence of age on
scapulo-thoracic orientation. Clin Biomech
(Bristol, Avon). 2004;19:1009-1013.
Downloaded from www.jospt.org at Asociación de Kinesiología del Deporte (AKD) on April 27, 2021. For personal use only. No other uses without permission.
13. Grey RG. The natural history of “idiopathic” frozen
shoulder. J Bone Joint Surg Am. 1978;60:564.
14. Ha’eri GB, Maitland A. Arthroscopic findings in the
frozen shoulder. J Rheumatol. 1981;8:149-152.
15. Hannafin JA, Chiaia TA. Adhesive capsulitis.
A treatment approach. Clin Orthop Relat Res.
2000;95-109.
16. Johnson GR, Stuart PR, Mitchell S. A method for
the measurement of three-dimensional scapular
movement. Clin Biomech. 1993;8:269-273.
17. Karduna AR, Kerner PJ, Lazarus MD. Contact
forces in the subacromial space: effects of
scapular orientation. J Shoulder Elbow Surg.
2005;14:393-399.
18. Karduna AR, McClure PW, Michener LA, Sennett
B. Dynamic measurements of three-dimensional
scapular kinematics: a validation study. J
Biomech Eng. 2001;123:184-190.
19. Kebaetse M, McClure P, Pratt NA. Thoracic
position effect on shoulder range of motion,
Copyright © 2007 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
strength, and three-dimensional scapular
kinematics. Arch Phys Med Rehabil. 1999;
80:945-950.
20. Loyd JA, Loyd HM. Adhesive capsulitis of the
shoulder: arthrographic diagnosis and treatment.
South Med J. 1983;76:879-883.
21. Ludewig PM, Cook TM. Alterations in shoulder
kinematics and associated muscle activity in
people with symptoms of shoulder impingement.
Phys Ther. 2000;80:276-291.
22. Ludewig PM, Cook TM, Nawoczenski DA.
Journal of Orthopaedic & Sports Physical Therapy®
Three-dimensional scapular orientation and
muscle activity at selected positions of humeral
elevation. J Orthop Sports Phys Ther.
1996;24:57-65.v
23. Lukasiewicz AC, McClure P, Michener L, Pratt
N, Sennett B. Comparison of 3-dimensional
scapular position and orientation between
subjects with and without shoulder impingement.
J Orthop Sports Phys Ther. 1999;29:574-583;
discussion 584-576.
journal of orthopaedic & sports physical therapy | volume 37 | number 1 | january 2007 |
JOSJan07_RundquistV5.indd 25
24. Manton GL, Schweitzer ME, Weishaupt D,
Karasick D. Utility of MR arthrography in the
diagnosis of adhesive capsulitis. Skeletal Radiol.
2001;30:326-330.
25. 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. Phys Ther. 2004;84:832-848.
26. McClure PW, Michener LA, Sennett BJ, Karduna
AR. Direct 3-dimensional measurement of
scapular kinematics during dynamic movements
in vivo. J Shoulder Elbow Surg. 2001;10:269-277.
27. Michiels I, Grevenstein J. Kinematics of shoulder
abduction in the scapular plane. On the influence
of abduction velocity and external load. Clin
Biomech (Bristol, Avon). 1995;10:137-143.
28. Munro BH. Statistical Methods for Health Care
Research. Philadelphia, PA: Lippincott Williams &
Wilkins; 2005.
29. Murnaghan JP. Adhesive capsulitis of the
shoulder: current concepts and treatment.
Orthopedics. 1988;11:153-158.
30. Neviaser JS. Adhesive capsulitis of the shoulder:
a study of the pathological findings in periarthritis
of the shoulder. J Bone Joint Surg Am.
1945;27:211-221.
31. Neviaser RJ, Neviaser TJ. The frozen shoulder.
Diagnosis and management. Clin Orthop Relat
Res. 1987;59-64.
32. Ogilvie-Harris DJ, Biggs DJ, Fitsialos DP, MacKay
M. The resistant frozen shoulder. Manipulation
versus arthroscopic release. Clin Orthop Relat
Res. 1995;238-248.
33. Parker RD, Froimson AI, Winsberg DD, Arsham
NZ. Frozen shoulder. Part I: Chronology,
pathogenesis, clinical picture, and treatment.
Orthopedics. 1989;12:869-873.
34. Placzek JD, Roubal PJ, Kulig K, Pagett BT,
Wiater JM. Theory and technique of translational
manipulation for adhesive capsulitis. Am J
Orthop. 2004;33:173-179.
35. Polhemus Inc. 3Space Fastrak User’s Manual,
Revision F. Colchester, VT: Polhemus; 1993.
36. Poppen NK, Walker PS. Normal and abnormal
motion of the shoulder. J Bone Joint Surg Am.
1976;58:195-201.
37. Reichmister JP, Friedman SL. Long-term
functional results after manipulation of the frozen
shoulder. MD Med J. 1999;48:7-11.
38. Rundquist PJ. Three-dimensional shoulder
kinematics in subjects with idiopathic loss
of shoulder range of motion [dissertation].
Minneapolis, MN: The University of Minnesota;
2003.
39. Rundquist PJ, Anderson DD, Guanche CA,
Ludewig PM. Shoulder kinematics in subjects
with frozen shoulder. Arch Phys Med Rehabil.
2003;84:1473-1479.
40. Rundquist PJ, Ludewig PM. Patterns of motion
loss in subjects with idiopathic loss of shoulder
range of motion. Clin Biomech (Bristol, Avon).
2004;19:810-818.
41. Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder.
A long-term follow-up. J Bone Joint Surg Am.
1992;74:738-746.
42. Soderberg GL. Kinesiology: Application to
Pathological Motion. Baltimore, MD: Williams &
Wilkins; 1986.
43. van der Helm FC, Pronk GM. Three-dimensional
recording and description of motions of
the shoulder mechanism. J Biomech Eng.
1995;117:27-40.
44. Vermeulen HM, Obermann WR, Burger BJ, Kok
GJ, Rozing PM, van Den Ende CH. End-range
mobilization techniques in adhesive capsulitis of
the shoulder joint: A multiple-subject case report.
Phys Ther. 2000;80:1204-1213.
45. Vermeulen HM, Rozing PM, Obermann WR, le
Cessie S, Vliet Vlieland TP. Comparison of high-
grade and low-grade mobilization techniques in
the management of adhesive capsulitis of the
shoulder: randomized controlled trial. Phys Ther.
2006;86:355-368.
46. Watson L, Dalziel R, Story I. Frozen shoulder: a
12-month clinical outcome trial. J Shoulder Elbow
Surg. 2000;9:16-22.
47. Wiley AM. Arthroscopic appearance of frozen
shoulder. Arthroscopy. 1991;7:138-143.
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