title: Dynamic Three-Dimensional Ultrasound to Evaluate Scapular Movement Among Manual Wheelchair Users and Healthy Controls.
abstract: BACKGROUND
  A large percentage of individuals with spinal cord injury (SCI) report shoulder pain that can limit independence and quality of life. The pain is likely related to the demands placed on the shoulder by transfers and propulsion. Shoulder pathology has been linked to altered scapular mechanics; however, current methods to evaluate scapular movement are invasive, require ionizing radiation, are subject to skin-based motion artifacts, or require static postures.
  
  
  OBJECTIVE
  To investigate the feasibility of applying 3-dimensional ultrasound methods, previously used to look at scapular position in static postures, to evaluate dynamic scapular movement.
  
  
  METHODS
  This study evaluated the feasibility of the novel application of a method combining 2-dimensional ultrasound and a motion capture system to determine 3-dimensional scapular position during dynamic arm elevation in the scapular plane with and without loading.
  
  
  RESULTS
  Incremental increases in scapular rotations were noted for extracted angles of 30°, 45°, 60°, and 75° of humeral elevation. Group differences were evaluated between a group of 16 manual wheelchair users (MWUs) and a group of age- and gender-matched able-bodied controls. MWUs had greater scapular external rotation and baseline pathology on clinical exam. MWUs also had greater anterior tilting, with this difference further accentuated during loading. The relationship between demographics and scapular positioning was also investigated, revealing that increased age, pathology on clinical exam, years since injury, and body mass index were correlated with scapular rotations associated with impingement (internal rotation, downward rotation, and anterior tilting).
  
  
  CONCLUSIONS
  Individuals with SCI, as well as other populations who are susceptible to shoulder pathology, may benefit from the application of this imaging modality to quantitatively evaluate scapular positioning and effectively target therapeutic interventions.
authors.affiliation: Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Worobey
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, Illinois.
authors.forename: Yen-Sheng
authors.initials: YS
authors.lastname: Lin
authors.affiliation: Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Koontz
authors.affiliation: Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006811:Humerus; D008297:Male; D008875:Middle Aged; D009068:Movement; D011187:Posture; D016059:Range of Motion, Articular; D012399:Rotation; D017006:Rotator Cuff; D012540:Scapula; D012782:Shoulder / Q000503:physiopathology*; D019534:Shoulder Impingement Syndrome; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications*; D014465:Ultrasonics; D014463:Ultrasonography / Q000379:methods*; D014910:Wheelchairs
keywords: kinematics; scapula; ultrasound; wheelchair user