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BACKGROUND: The trapezius is an extensive muscle subdivided into upper, middle, and lower parts. This muscle is a dominant stabilizer of the scapula, normally operating synergistically with other scapular muscles, most notably the serratus anterior. Altered activation, poor control, or reduced strength of the different parts of the trapezius have been linked with abnormal scapular movements, often associated with pain. Several exercises have been designed and studied that specifically target the different parts of the trapezius, with the goal of developing exercises that optimize scapular position and scapulohumeral rhythm that reduce pain and increase function. METHODS: This paper describes the anatomy, kinesiology, and pathokinesiology of the trapezius as well as exercises that selectively target the activation of the different parts of this complex muscle. CONCLUSIONS: This review provides the anatomy and kinesiology of the trapezius muscle with the underlying intention of understanding how this muscle contributes to the normal mechanics of the scapula as well as the entire shoulder region. This paper can guide the clinician with planning exercises that specifically target the different parts of the trapezius. It is recommended that this paper be read as a companion to another paper: Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 1: serratus anterior.

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BACKGROUND: The serratus anterior (SA) is capable of a wide range of actions across the scapulothoracic joint. Furthermore, the lack of control, strength, or activation of this important muscle is believed to be associated with several painful conditions involving the shoulder complex. Studies and clinical intuition have therefore identified several exercises that selectively target the activation of the SA. METHODS: This paper reviews the anatomy, innervation, testing, and complex actions of the SA. In addition, this paper describes the classic signs and symptoms of weakness or reduced activation of the SA. Several exercises are described and illustrated that purportedly target the activation of the SA, with the intention of optimizing muscular control and encouraging pain free shoulder motion. CONCLUSIONS: This review provides the theoretical background and literature-based evidence that can help explain the SA's complex pathokinesiology, as well as guide the clinician to further develop exercises that likely challenge the muscle. This paper is written along with a companion paper entitled: Kinesiologic considerations for targeting activation of scapulothoracic muscles: part 2: trapezius. Both papers prepare the reader to expand their pallet of exercises that target and challenge these two dominant muscles, with a goal of improving function of the shoulder for several painful conditions caused by their reduced or altered activation pattern.

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The relationship between shoulder pain and scapular dyskinesis (SDK) is unclear. Differences between groups with and without SDK have been demonstrated, focusing on the amount of scapular motion at specific degrees of humeral elevation. However, this approach does not consider the temporal information and shape of the scapular motion temporal series. Principal Component Analysis (PCA) may clarify this variability and advance current understanding of 'abnormal' movement patterns. This study aimed to evaluate the scapular kinematics in patients with shoulder pain and in asymptomatic participants with and without SDK using PCA. Data were collected in 98 participants separated in four groups: Pain + SDK (n = 24), Pain (n = 25), No Pain + SDK (n = 24), and No Pain (n = 25). Scapulothoracic kinematic data were measured with an electromagnetic tracking device during arm elevation and lowering phases. PCA and analysis of variance were used to compare the groups. The No Pain + SDK group had a progressive increasing in anterior tilt over the elevation phase compared to the Pain (effect size = 0.79) and No Pain (effect size = 0.80) groups. During the arm-lowering, the Pain + SDK group had a progressive increasing in anterior tilt over this phase in comparison to the No Pain + SDK group (effect size = 0.68). Therefore, PCA demonstrated differences in the scapular anterior tilt related to SDK and shoulder pain. The presence of SDK revealed a scapular pattern with progressive increasing in anterior tilt over the elevation phase. However, during the arm-lowering phase, asymptomatic participants with SDK changed their motion pattern, unlike the symptomatic group, reinforcing the suggested association between scapular modifications and shoulder symptoms.

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Traumatic scapulothoracic dissociation represents the separation of the scapula from the chest wall. The mechanism of this trauma involves a severe traction applied to the upper member which translates into neurovascular and musculoskeletal injuries secondary to trauma. This lesion often goes unnoticed for appearing in conjunction with major trauma or presenting with bizarre symptoms. On physical examination, patients exhibit swelling of soft tissue around the shoulder and upper limb. Lateral displacement of scapula greater than 1 cm is the classic radiological finding on thoracic imaging studies. The key is to compare the distance from medial borders of the scapula to midline (dorsal column).

La disociación escapulotorácica traumática como su nombre lo indica, se define como la separación de la escápula de la pared del tórax. El mecanismo de este trauma implica una tracción severa aplicada al miembro superior con lesiones neurovasculares y musculoesqueléticas secundarias. Esta lesión suele pasar desapercibida por presentarse en conjunto con traumas mayores o cursar con síntomas bizarros. Al examen físico, los pacientes presentan edema de tejidos blandos alrededor del hombro y de la parte superior de la extremidad. El hallazgo radiológico clásico en la radiografía de tórax es el desplazamiento lateral mayor a 1 cm de la escápula con respecto al tórax. La clave está en comparar la distancia de los bordes mediales de las escápulas en relación a una línea media en la columna dorsal.

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INTRODUCCIËN: El Síndrome de Roce Escápulo-torácico es una causa de dolor en la región posterior del hombro y que puede ser causado por una disfunción de esta articulación. Cuando falla el tratamiento conservador o cuando se debe a lesiones tumorales, está indicado el tratamiento quirúrgico. Con el presente trabajo nos propusimos evaluar los resultados obtenidos con este tratamiento en nuestro grupo de estudio. MÉTODOS: Se realizó un estudio de intervención en 17 pacientes portadores de un Síndrome de Roce Escápulo - torácico, que fueron atendidos quirúrgicamente en el Servicio de Miembro Superior del Complejo Científico Ortopédico Internacional Frank País entre marzo 2002 y marzo 2008. La técnica quirúrgica estuvo en correspondencia con la causa desencadenante del Roce Escápulo- torácico. La valoración funcional de los resultados se efectuó a los 6 meses de la operación, se tuvo como referencia tres de las categorías del Test de valoración funcional del hombro de la Universidad de los Ángeles, California (dolor, función y grado de satisfacción del paciente); además se le agregaron a este test, tres categorías para nuestro estudio (flexión, abducción y antepulsión). RESULTADOS: La edad promedio en nuestra serie fue de 31,8 años; 15 pacientes (89,4 por ciento) correspondieron al sexo femenino, los grupos de edades más afectados los menores de 20 años y entre 31 a 40 con 6 casos cada uno, predominaron las lesiones en el miembro dominante 10 pacientes (58,8 por ciento) y aparecieron con mayor frecuencia en los intelectuales. La evaluación del dolor, la función, la flexión, la abducción y la antepulsión mostró una tendencia significativa a la mejoría del puntaje. El 82 por ciento de los pacientes tuvieron resultados excelente o bueno(AU)

INTRODUCTION: The scapulothoracic friction syndrome is a pain cause in the posterior area of the shoulder and that may be provoked by a dysfunction of this joint. When conservative treatment fails or when it is due to tumor injuries, surgical treatment is prescribed. The aim of present paper is to assess the results obtained with this type of treatment in our study group. METHODS: An intervention study was conducted in 17 patients with a scapulothoracic friction syndrome operated on the Upper Member Service of the Frank País International Orthopedics Scientific Complex from March, 2002 to March, 2008. Surgical technique was in correspondence with the triggering cause of this syndrome. Functional assessment of results was made at 6 months after surgery taking into account three categories of the Shoulder Functional Assessment Test of the Los Angeles University, California (pain, function and the patient's satisfaction grade), also for our study, three categories more were added to this test (flexion, abduction and antepulsion). RESULTS: Mean age in our series was of 31,8 years; 15 patients (89,4 percent were women, the more involved age groups were those under 20 years and between 31 to 40 years each, with predominance of the dominant limb in 10 patients (58,8 percent) with greater frequency in the intellectual ones. Assessment of pain, function, flexion, abduction and antepulsion showed a significant trend to improve of score. The 82 percent of patients showed excellent or good results(AU)

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INTRODUCCIÓN: Las crisis de sacrolumbalgias agudas no específicas presentan una alta incidencia y constituyen un problema que afecta mayormente a pacientes en edad laboral. El presente trabajo tiene como objetivo principal el de establecer diferencias entre el uso o no de la electroacupuntura en el tratamiento de la crisis de sacrolumbalgia aguda no específica. MÉTODOS: Se realizó un estudio experimental terapéutico del tipo ensayo clínico, en 100 pacientes de ambos sexos y edades entre 27 y 65 años que asistieron al departamento de medicina tradicional, sección de consulta externa del Complejo Científico Ortopédico Internacional Frank País procedentes de la consulta externa de ortopedia de la institución y de áreas de salud del municipio La Lisa.Se aplicaron criterios de exclusión y se dividieron en dos grupos, uno recibió tratamiento de electroacupuntura y el otro tratamiento convencional. RESULTADOS: El tratamiento con electroacupuntura mostró ser más eficaz tanto en relación con el inicio en la remisión de los síntomas dolorosos como en el tiempo necesario para la remisión completa. CONCLUSIÓN: Por lo anterior la terapia con electroacupuntura se recomienda en el tratamiento de la sacrolumbalgia aguda no específica(AU)

INTRODUCTION: The scapulothoracic friction syndrome is a pain cause in the posterior area of the shoulder and that may be provoked by a dysfunction of this joint. When conservative treatment fails or when it is due to tumor injuries, surgical treatment is prescribed. The aim of present paper is to assess the results obtained with this type of treatment in our study group. METHODS: An intervention study was conducted in 17 patients with a scapulothoracic friction syndrome operated on the Upper Member Service of the Frank País International Orthopedics Scientific Complex from March, 2002 to March, 2008. Surgical technique was in correspondence with the triggering cause of this syndrome. Functional assessment of results was made at 6 months after surgery taking into account three categories of the Shoulder Functional Assessment Test of the Los Angeles University, California (pain, function and the patient's satisfaction grade), also for our study, three categories more were added to this test (flexion, abduction and antepulsion). RESULTS: Mean age in our series was of 31,8 years; 15 patients (89,4 percent were women, the more involved age groups were those under 20 years and between 31 to 40 years each, with predominance of the dominant limb in 10 patients (58,8 percent) with greater frequency in the intellectual ones. Assessment of pain, function, flexion, abduction and antepulsion showed a significant trend to improve of score. The 82 percent of patients showed excellent or good results(AU)

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INTRODUCCIËN: El Síndrome de Roce Escápulo-torácico es una causa de dolor en la región posterior del hombro y que puede ser causado por una disfunción de esta articulación. Cuando falla el tratamiento conservador o cuando se debe a lesiones tumorales, está indicado el tratamiento quirúrgico. Con el presente trabajo nos propusimos evaluar los resultados obtenidos con este tratamiento en nuestro grupo de estudio. MÉTODOS: Se realizó un estudio de intervención en 17 pacientes portadores de un Síndrome de Roce Escápulo - torácico, que fueron atendidos quirúrgicamente en el Servicio de Miembro Superior del Complejo Científico Ortopédico Internacional Frank País entre marzo 2002 y marzo 2008. La técnica quirúrgica estuvo en correspondencia con la causa desencadenante del Roce Escápulo- torácico. La valoración funcional de los resultados se efectuó a los 6 meses de la operación, se tuvo como referencia tres de las categorías del Test de valoración funcional del hombro de la Universidad de los Ángeles, California (dolor, función y grado de satisfacción del paciente); además se le agregaron a este test, tres categorías para nuestro estudio (flexión, abducción y antepulsión). RESULTADOS: La edad promedio en nuestra serie fue de 31,8 años; 15 pacientes (89,4 por ciento) correspondieron al sexo femenino, los grupos de edades más afectados los menores de 20 años y entre 31 a 40 con 6 casos cada uno, predominaron las lesiones en el miembro dominante 10 pacientes (58,8 por ciento) y aparecieron con mayor frecuencia en los intelectuales. La evaluación del dolor, la función, la flexión, la abducción y la antepulsión mostró una tendencia significativa a la mejoría del puntaje. El 82 por ciento de los pacientes tuvieron resultados excelente o bueno

INTRODUCTION: The scapulothoracic friction syndrome is a pain cause in the posterior area of the shoulder and that may be provoked by a dysfunction of this joint. When conservative treatment fails or when it is due to tumor injuries, surgical treatment is prescribed. The aim of present paper is to assess the results obtained with this type of treatment in our study group. METHODS: An intervention study was conducted in 17 patients with a scapulothoracic friction syndrome operated on the Upper Member Service of the Frank País International Orthopedics Scientific Complex from March, 2002 to March, 2008. Surgical technique was in correspondence with the triggering cause of this syndrome. Functional assessment of results was made at 6 months after surgery taking into account three categories of the Shoulder Functional Assessment Test of the Los Angeles University, California (pain, function and the patient's satisfaction grade), also for our study, three categories more were added to this test (flexion, abduction and antepulsion). RESULTS: Mean age in our series was of 31,8 years; 15 patients (89,4 percent were women, the more involved age groups were those under 20 years and between 31 to 40 years each, with predominance of the dominant limb in 10 patients (58,8 percent) with greater frequency in the intellectual ones. Assessment of pain, function, flexion, abduction and antepulsion showed a significant trend to improve of score. The 82 percent of patients showed excellent or good results

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INTRODUCCIÓN: Las crisis de sacrolumbalgias agudas no específicas presentan una alta incidencia y constituyen un problema que afecta mayormente a pacientes en edad laboral. El presente trabajo tiene como objetivo principal el de establecer diferencias entre el uso o no de la electroacupuntura en el tratamiento de la crisis de sacrolumbalgia aguda no específica. MÉTODOS: Se realizó un estudio experimental terapéutico del tipo ensayo clínico, en 100 pacientes de ambos sexos y edades entre 27 y 65 años que asistieron al departamento de medicina tradicional, sección de consulta externa del Complejo Científico Ortopédico Internacional Frank País procedentes de la consulta externa de ortopedia de la institución y de áreas de salud del municipio La Lisa.Se aplicaron criterios de exclusión y se dividieron en dos grupos, uno recibió tratamiento de electroacupuntura y el otro tratamiento convencional. RESULTADOS: El tratamiento con electroacupuntura mostró ser más eficaz tanto en relación con el inicio en la remisión de los síntomas dolorosos como en el tiempo necesario para la remisión completa. CONCLUSIÓN: Por lo anterior la terapia con electroacupuntura se recomienda en el tratamiento de la sacrolumbalgia aguda no específica

INTRODUCTION: The scapulothoracic friction syndrome is a pain cause in the posterior area of the shoulder and that may be provoked by a dysfunction of this joint. When conservative treatment fails or when it is due to tumor injuries, surgical treatment is prescribed. The aim of present paper is to assess the results obtained with this type of treatment in our study group. METHODS: An intervention study was conducted in 17 patients with a scapulothoracic friction syndrome operated on the Upper Member Service of the Frank País International Orthopedics Scientific Complex from March, 2002 to March, 2008. Surgical technique was in correspondence with the triggering cause of this syndrome. Functional assessment of results was made at 6 months after surgery taking into account three categories of the Shoulder Functional Assessment Test of the Los Angeles University, California (pain, function and the patient's satisfaction grade), also for our study, three categories more were added to this test (flexion, abduction and antepulsion). RESULTS: Mean age in our series was of 31,8 years; 15 patients (89,4 percent were women, the more involved age groups were those under 20 years and between 31 to 40 years each, with predominance of the dominant limb in 10 patients (58,8 percent) with greater frequency in the intellectual ones. Assessment of pain, function, flexion, abduction and antepulsion showed a significant trend to improve of score. The 82 percent of patients showed excellent or good results

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Objetivo: Descrever cinco casos de elastofibroma dorsi (quatro unilateral e um bilateral) em pacientes que foram tratados previamente como tendinopatia do ombro. Materiais e métodos: Os pacientes referiam dor na região do trapézio, além de história, testes clínicos e exames de imagem positivos para tendinopatia do manguito rotador. Foram tratados previamente de forma não cirúrgica, por meio de medicamentos e fisioterapia, sendo encaminhados para tratamento artroscópico (descompressão subacromial e reparo do manguito rotador). Ao procurarem nosso serviço, em todos os casos se notou ao exame físico: discinesia escapulotorácica, ressalto e crepitação. Resultados: Optou-se pelo tratamento cirúrgico de forma aberta (ressecção tumoral), após diagnóstico por imagem compatível com elastofibroma dorsi. Realizou-se a ressecção da tumoração em três pacientes, pois dois recusaram o tratamento cirúrgico. Nos casos operados, o exame anatomopatológico confirmou o diagnóstico. Todos os pacientes operados obtiveram melhora do quadro de síndrome do impacto non-outlet. Conclusão: Os autores destacam que, embora rara, essa afecção deva ser considerada como diagnóstico diferencial da síndrome do impacto subacromial e salientam a importância do exame físico, em especial da articulação escapulotorácica para o correto diagnóstico desta lesão pseudotumoral.

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