Ann Rehabil Med.  2019 Apr;43(2):178-186. 10.5535/arm.2019.43.2.178.

Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke

• Ratanapinunchai J
• Mathiyakom W
• Sungkarat

• KMID: 2449000
• DOI: http://doi.org/10.5535/arm.2019.43.2.178

Abstract

OBJECTIVE
To describe scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke compared to normal subjects.
METHODS
Twenty-five individuals with hemiplegia post-stroke and 25 age- and gender-matched normal subjects voluntarily participated in this study. Scapular upward rotation during resting and passive humeral abduction at 30°, 60°, 90°, 120°, and 150° were measured using a digital inclinometer.
RESULTS
In both groups, scapular upward rotation significantly increased as humeral abduction increased (p<0.001). Scapular upward rotation was significantly less in the hemiplegic group compared to that in the control at 90° (p=0.002), 120° (p<0.001), and 150° of humeral abduction (p<0.001). The mean difference in scapular upward rotation between these two groups ranged from 6.3° to 11.38°.
CONCLUSION
Passive humeral abductions ranging from 90° to 150° can significantly alter scapular upward rotation in individuals with hemiplegia post-stroke compared to those of matched normal subjects. The magnitude of reduction of the scapular upward rotation may potentially lead to the development of hemiplegic shoulder pain after prolonged repetitive passive movement. Scapular upward rotation should be incorporated during passive humeral abduction in individuals with hemiplegia post-stroke, especially when the humeral is moved beyond 90° of humeral abduction. Combined movements of scapular and humeral will help maintain the relative movement between the scapula and humerus. However, further longitudinal study in patients with shoulder pain post-stroke is needed to confirm these findings.

Keyword

Scapular; Shoulder; Range of motion; Stroke

MeSH Terms

Hemiplegia*
Humans
Humerus
Longitudinal Studies
Range of Motion, Articular
Scapula
Shoulder
Shoulder Pain
Stroke

Figure

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  Fig. 1. (A) The setting posture of participants with a sternal stabilizer and a gravitational goniometer to measure glenohumeral abduction. (B, C) Position of a modified digital inclinometer during measuring of scapular upward rotation. (C) Two markers (black arrows) formed a scapular spine line.

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  Fig. 2. Comparisons of scapular upward rotation at resting and during passive humeral abduction at 30°, 60°, 90°, 120°, and 150° between flaccid group and mildly spastic group. Error bars indicate standard errors of the means. There was no statistically significant difference between the flaccid group and the mildly spastic group. There was a significant difference in scapular upward rotation when compared between humeral positions. *p<0.001.

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  Fig. 3. Comparisons of scapular upward rotation at resting and during passive humeral abduction at 30°, 60°, 90°, 120°, and 150° between the control group and the hemiplegic group. Error bars indicated standard errors of the means. Scapular upward rotation was significantly less at 90° (p=0.002), 120° (p<0.001), and 150° (p<0.001) of passive humeral abduction in the hemiplegic group compared to the control group. *p<0.05.

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