Scapular and humeral movement patterns of people with stroke during range-of-motion exercises

BACKGROUND AND PURPOSE: Range-of-motion (ROM) exercises may contribute to hemiparetic shoulder pain, but the underlying mechanisms are unknown. This study examined scapular and humeral movement patterns in people with hemiparesis post stroke as they performed commonly prescribed ROM exercises. METHODS: Using kinematic techniques, we studied 13 people with hemiparesis, both with and without pain, as they performed three commonly prescribed ROM exercises: person-assisted ROM, self-assisted ROM, and cane-assisted ROM. Their data were compared to a group of 12 matched control subjects performing scapular plane shoulder elevation using mixed model ANOVAs. Correlation analyses were used to examine the relationship between participants’ ratings of pain and kinematic data. RESULTS: The hemiparetic group had mild pain at rest that increased during the performance of the exercises. During shoulder elevation, humeral external rotation in the hemiparetic group was decreased in all three ROM exercises compared to the control group. Scapular upward rotation in the hemiparetic group was decreased for the person-assisted ROM exercise only. No differences in scapular tilt were found between groups. The extent of movement abnormalities was not related to pain severity. DISCUSSION AND CONCLUSIONS: People with hemiparesis had altered scapular and humeral movement patterns and increased shoulder pain when performing the ROM exercises. These data can assist clinicians in making decisions regarding which exercises to prescribe to preserve shoulder motion and prevent contractures in this population

Scapula and humeral movement patterns and their relationship with pain: a preliminary investigation

Dustin D Hardwick, Catherine E Lang Aims: Altered movement patterns may contribute to this shoulder pain following stroke. This article describes a study examining scapular and humeral movement patterns in people with hemiparetic shoulder pain (HSP), exploring the relationship between pain and these movement patterns. Methods: Kinematic data from nine participants with HSP and twelve matched controls were collected as they performed scapular plane shoulder elevation. Correlation analyses were used to examine relationships between participants’ ratings of pain and kinematic data. Findings: The HSP group had decreased humeral external rotation compared to the control group. Despite a trend toward decreased scapular upward rotation, there was considerable variation in scapular upward rotation movement patterns across the participants with HSP. Scapular tilt was not different between groups. There was an inverse relationship between pain and scapular upward rotation, indicating that those with more pain had less scapular upward rotation. Conclusions: People with HSP demonstrated scapular and humeral movement patterns that differed from controls, where some of the altered movement patterns were related to reported pain levels. Rehabilitation management of people with HSP may be improved by careful assessment of scapulohumeral movement patterns and treatments aimed at normalizing these patterns. </jats:p