Summary

A computer tablet software (PIVOT image-based analysis software) was validated to provide quantitative data of scapula motion during clinical assessment for scapular dyskinesia.

Abstract

Introduction-Aim: Clinical evaluation of scapular dyskinesia is currently achieved with subjective visual observation of scapular motion. Quantitative measure of scapular motion would improve the accuracy of assessment of the existence and grade of scapular dyskinesia in the diagnostic process. Aim of the present study is to establish an objective and easily applicable method that will allow clinicians to quantitatively assess scapular motion during clinical examination for scapular dyskinesia using a computer tablet software. Hypothesis is that dyskinetic scapulae present greater motion compared to the non-dyskinetic ones.

Materials And Methods

This is a prospective study including 15 patients suffering from unilateral dyskinesia and shoulder or back pain and 10 healthy controls having no dyskinesia or symptoms. The cohort was clinically evaluated for the presence of dyskinesia during arms raising and lowering and both scapulae were rated as “Yes” or “No”. Then, all individuals were tested using a tablet with the PIVOT TM image-based analysis software (PIVOT, Impellia, Pittsburgh, PA, USA). The markers placement was adjusted following trials. The first static marker (S1) was placed to T2 spinous process and the second static marker (S2) was placed on the same transverse plane and 80 mm lateral to S1. The mobile marker (M1) was placed on the medial border of the inferior angle of the scapula. Scapula motion was recorded during arms lowering to capture any kinematic motion associated with scapular dyskinesia. According to the clinical diagnosis, the observations were divided into 3 groups; a. Dyskinetic scapulae with symptoms (n=15), b. Contralateral non-dyskinetic scapulae without symptoms (n=15), c. Healthy control scapulae (n=20). Wilcoxon Signed-Ranks Test and Mann-Whitney U Test were applied to examine whether dyskinetic scapulae (group a) presented significantly greater motion than the two other groups.

Results

The video analysis software revealed the following data with regard to the scapula motion; group a: 24.9 mm, group b: 14.3 mm, group c: 14.5 mm. The motion recorded in the dyskinetic scapulae group was significantly greater than both the contralateral non-dyskinetic scapulae group (Wilkoxon Signed-Ranks Test, p<0.05) and the healthy control scapulae group (Mann-Whitney U Test, p<0.001)

Conclusion

The hypothesis was confirmed and thus PIVOT TM image-based analysis software was validated to provide quantitative data of scapula motion supplemental to clinical examination for scapular dyskinesia. A potential clinical application of this method is the pre-participation assessment of scapula motion in overhead athletes. Following prescription of an exercise program, the orthopaedic surgeon, physiotherapist or athletic trainer may test the athletes again. Whether this test is helpful to monitor treatment, it should be evaluated in a future study with correlation to patient reported outcomes. At the moment, further observations are necessary to optimize the software for the scapula and define which amount of captured motion is clinically significant.