Indivíduos com Teste de Assistência Escapular positivo apresentam alterações na cinemática escapular e força muscular?

Abstract

Introduction: The Scapular Assistance Test has as principle the therapist to manually assist the scapula in upward rotation and posterior tilt during arm elevation performed by the patient in an attempt to reduce pain and increase arm range of motion of the arm. However, it is not yet clear in the literature if individuals with this test as positive really present scapular movement patterns and muscle strength different from those with the test as negative. Objective: The aim of this study was to compare scapular kinematics, characterize the coordination between scapula and humerus, and to compare muscle strength in individuals with unilateral shoulder pain with positive and negative Scapular Assistance Test. Methods: Sixty individuals with shoulder pain participated in the study and were allocated to one of the two groups: positive Scapular Assistance Test (n=30) and negative Scapular Assistance Test (n=30). Scapular kinematics during elevation and lowering of the arm in sagittal plane, and muscle strength of serratus anterior, lower trapezius and external rotators of the arm were assessed in all individuals. The coordination between scapula and humerus was analyzed in qualitative way during the entire range of elevation and lowering of the arm and from the beginning of the painful arc. Results: There was no group x angle interaction (p>0.05) and no group main effect (p>0.05) during internal rotation and upward rotation of the scapula. There was no group x angle interaction (p<0.05) during posterior tilt of the scapula, but there was group main effect during elevation (p<0.05) and lowering (p<0.05) of the arm, whereas the group with positive Scapular Assistance Test presented greater anterior tilt of the scapula. The group with positive Scapular Assistance Test had greater contribution of the internal rotation and lower of the posterior tilt of the scapula from the beginning of the painful arc. There was no difference (p>0.05) in the strength of the serratus anterior, lower trapezius and external rotators of the arm between both groups. Conclusion: The positive Scapular Assistance Test appears to be able to identify subgroups of individuals who exhibit reduced posterior tilt of the scapula, and increased internal rotation of the scapula during the painful arc of arm elevation. The pain seems to influence the coordination between scapula and humerus during the painful arc. There are no differences in upward rotation of the scapula, and in the strength of the serratus anterior, lower trapezius and external rotators of the arm among the individuals with shoulder pain.