Download Effect of scapular elevation taping on scapular

187
Journal of Back and Musculoskeletal Rehabilitation 25 (2012) 187–191
DOI 10.3233/BMR-2012-0326
IOS Press
Case Report
Effect of scapular elevation taping on scapular
depression syndrome: A case report
Jung-Hoon Leea,c and Won-Gyu Yoob,∗
a
Department of Physical Therapy, Inje University Pusan Paik Hospital, Inje University, Gimhae, Republic of Korea
Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae,
Republic of Korea
c
Department of Physical Therapy, The Graduate School, Inje University, Gimhae, Republic of Korea
b
Abstract. Objective: This report describes the application of scapular elevation taping (SET) using kinesio tape to elevate the
scapula and treat upper trapezius (UT) muscle tenderness in a patient with scapular depression syndrome.
Methods: The patient was a 22-year-old man who had scapular depression and severe tenderness of the right UT. We performed
SET for 2 months, 4 days a week, for an average of 9 h each day, to provide scapular elevation.
Results: At the last assessment, the right superior angle of the scapula and the lateral border of the acromion were slightly elevated
compared with the spinous process of the second thoracic vertebra. A chest X-ray showed that the right coracoid process was
higher compared to the initial level and that the level of the first ribs was similar on both sides. The pressure-pain threshold in the
UT increased from 1 to 8 kg and the tenderness at 3 kg, assessed on a numeric rating scale, decreased from 6 to 0. No tenderness
occurred when carrying a bag with the right hand or slinging a bag over the right shoulder.
Conclusion: Continuous application of SET may be used as a supplementary method for scapular elevation and reduction in
patients with UT tenderness.
Keywords: Kinesio tape, pressure pain threshold, scapular depression syndrome, scapular elevation taping, upper trapezius muscle
1. Introduction
Scapular depression syndrome is characterized by
scapular depression that leads to neck and shoulder
pain [1]. The scapula is considered to be depressed
when the superior angle of the scapula (SAS) is situated
below the spinous process of the second thoracic vertebra (SP2) [1,2]. Scapular depression syndrome is associated with lengthening or weakening [1] and a lower pressure pain threshold (PPT) in the upper trapezius (UT) muscle [3]. However, few studies have ex∗ Corresponding author: Won-gyu Yoo, PhD., Department of Physical Therapy, College of Biomedical Science and Engineering, Inje
University 607 Obang-dong, Gimhae, Gyeongsangnam-do, 621-749,
Republic of Korea. Tel.: +82 55 320 3994; Fax: +82 55 329 1678;
E-mail: [email protected].
amined scapular depression syndrome, and few reports
have described favorable therapeutic methods of scapular repositioning in patients with scapular depression
syndrome.
Kinesio taping is a relatively new treatment technique, which is increasingly becoming an adjunct treatment with other therapeutic methods used for various
musculoskeletal and neuromuscular problems [4]. Several recent reports have described that Kinesio taping
may stimulate cutaneous mechanoreceptors [5], relieve
pain [4,6,7], assist postural alignment [8], and increase
muscular bioelectric activity [9,10]. However, the effect of Kinesio taping on scapular malalignment has
not been sufficiently studied. Therefore, we describe
the application of scapular elevation taping (SET) to elevate the scapula and to treat UT tenderness in a patient
with scapular depression syndrome.
ISSN 1053-8127/12/$27.50  2012 – IOS Press and the authors. All rights reserved
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J.-H. Lee and W.-G. Yoo / Effect of scapular elevation taping on scapular depression
Fig. 1. The patient’s depressed right scapula; the superior angle of the
scapula (SAS) was below the spinous process of the second thoracic
vertebra (SP2).
2. Case report
The patient was a 22-year-old man who had no specific surgical or medical history of the shoulder. For
2 months, he had experienced severe tenderness in the
right UT when carrying a bag in the right hand, slinging
a bag over the right shoulder (the patient habitually carried or slung a heavy bag [weight, > 10 kg] on his right
shoulder for an average of 5 h a day), or elevating the
right upper extremity to hold a strap in a bus or subway.
He did not undergo any treatment; the severe tenderness in the right UT was relieved when the scapula was
passively elevated for achieving normal alignment.
Skin surface landmarks are useful reference points
for determining the location of selected bony areas on
the scapula and thoracic spine [11]. To assess the position of such relevant landmarks, the examiner marked
3 anatomic references (SAS, the lateral border of the
acromion [A], and SP2) with a black pen while the
patient was in an upright standing position with his
arms to the sides. In an ideal scapular position, SAS
and A are on the same level or above SP2. Because
the patient’s right SAS and A were lower than SP2,
his scapula was found to be depressed compared with
the ideal scapular alignment [3] (Fig. 1). In addition,
chest X-ray showed that the coracoid process and first
rib were lower on the right side than on the left side;
thoracic scoliosis was also observed (Fig. 2).
The PPT was measured with an algometer (Pain TestModel FPK; Wagner Instruments, Greenwich, CT) in
the middle of the UT between SP2 and A while the
Fig. 2. The patient’s initial chest X-ray (arrow, coracoid process).
patient was sitting on a stool; the PPT was 1 kg before treatment. The PPT is a useful clinical tool [12]
because it is believed to be related to different etiologies, including excessive strain and soft tissue tenderness [13]. The tenderness at 3 kg using an algometer [14], assessed on a numeric rating scale from 0 to
10 (i.e., 0 representing no pain and 10 representing the
worst imaginable pain), was 6.
We performed SET for 2 months, 4 days a week,
for an average of 9 h each day, to provide scapular elevation. SET was performed by a Kinesio taping expert; the Kinesio tape (KT-X-050; Kinesio Tex,
Tokyo, Japan) was stretched to 55–60% of the original
length [15]. For SET application, an I-type strip with
approximately 75% of the available tension, according
to the guideline for stretching reported by Kase [15],
was applied. The strip was applied (in this order) while
the scapular elevation was passively maintained by an
assistant: (1) from the inferior scapular angle towards A
(Fig. 3a), (2) from the midpoint of the medial scapular
border toward the UT (Fig. 3b), and (3) from the inferior scapular angle towards the cervical spine (Fig. 3c)
(Fig. 3; arrow, direction of tape application). To prevent an adverse reaction to the tape, the Kinesio tape
was removed immediately if the patient developed itchiness. In addition, carrying a bag by hand or slinging
a bag over the shoulder, which contributed to the depressed position of the scapula in the present patient,
should be avoided as much as possible [1]. No other
physical therapy or home exercise was used to treat the
scapular depression or the tenderness of the right UT.
After applying SET for 1 week, the PPT increased
from 1 to 3 kg and the tenderness at 3 kg, assessed on
J.-H. Lee and W.-G. Yoo / Effect of scapular elevation taping on scapular depression
Fig. 3. Application of kinesio tape to achieve right scapular elevation.
a numeric rating scale, decreased from 6 to 3. After
applying SET for 1 month, the PPT increased to 6 kg
and the tenderness at 3 kg, assessed on a numeric rating
scale, decreased to 0. At the last assessment, following
SET for 2 months, the PPT increased to 8 kg and the
right SAS and A was slightly elevated compared with
SP2. On chest X-ray, the right coracoid process was
higher compared to the initial level and the level of the
first rib was similar on both sides (Fig. 4). However, a
precise match of the location of both scapulae was difficult because of the observed thoracic scoliosis. Tenderness did not occur when the patient elevated his right
upper limb, carried a bag in his right hand, or slung a
bag over his right shoulder.
3. Discussion
The influence of scapular depression syndrome on
neck and shoulder regions was first described by
Sahrmann [1]. Symptoms and diagnoses associated
with scapular depression syndrome include acromioclavicular joint pain, rotator cuff tear, humeral subluxation, neck pain with or without radiating pain into
the arm, thoracic outlet syndrome, pain of the trapezius and levator scapulae muscles, and glenohumeral
joint impingement [1]. During glenohumeral joint flexion/abduction, scapular depression leads to insufficient
elevation, and the amount of shoulder girdle elevation
must increase to compensate for the depressed starting
position [1]. In addition, prolonged time in the depressed scapular position may lead to chronic increased
tension, pain, and decreased PPT in the UT [3] and
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Fig. 4. The patient’s final chest X-ray (arrow, coracoid process).
scapula elevator muscles [1]. Although the relationship
between alignment and pain is still unclear, alignment
is known to be one of numerous factors contributing
to the development of mechanical pain [16]. Data on
previously reported cases of healthy young people with
scapular depression have shown that their PPT values
for the UT muscle were lower than those for healthy
young people with an ideal scapular position [3].
The most important treatment for scapular depression syndrome is providing passive support to the
scapula for achieving neutral alignment of the scapula [1]. A previous study showed that elevating the
scapula passively during upper extremity activities in
subjects with depressed shoulders was an effective
method for reducing trapezius symptoms and neck
pain [17].
In this case, based on previous reports that scapular elevation is beneficial for decreasing symptoms of
scapular depression syndrome [1,3], two scapular elevation procedures were performed. First, the scapulae were manually elevated after the assistant placed
a hand in each of the patient’s axillae [18]. Second,
the application of Kinesio tape with severe tension (approximately 75% of the available tension) [15] may
help maintain the elevated scapular position when the
tape is applied to the scapula in the elevated position.
Unlike conventional tape, Kinesio tape has an elasticity
of 55–60% of the original length [15]. According to
the guideline for stretching reported by Kase [15], the
tension required for mechanical correction is 50–75%
of the available tension. The tension created by applying SET involving severe tension may cause resistance
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J.-H. Lee and W.-G. Yoo / Effect of scapular elevation taping on scapular depression
to scapular depression. In addition, because applying
Kinesio tape may affect tactile stimulation [19], the
perception of increased tension in the scapular depression position after SET application causes scapular elevation for normalizing the perceived skin tension [15].
In a report of hemiplegic patients, Kinesio taping increased the stability of the thoracic spine and scapula
and provided feedback regarding the preferred postural alignment to the muscle [8]. A recent study has
reported passive joint support achieved using Kinesio
tape alone for preventing changes in posterior pelvic
tilt due to slump sitting by workers [20]. In addition,
continuous Kinesio tape application enabled mechanical correction such as changes in the pelvic inclination and sacral horizontal angle [21]. In this case, SET
application around the scapula for 2 months elevated
the scapula and reduced UT tenderness. Hence, the
continuous application of SET may be a supplementary
method for scapular elevation.
Additionally, the application of Kinesio tape to the
skin may stimulate cutaneous mechanoreceptors [5].
According to the counterirritant theory, increased
mechanoreceptive afferent input inhibits the transmission of nociceptive signals through the release of
enkephalin, which results in hyperpolarization of interneurons and inhibition of substance P release (i.e.,
the neurotransmitter involved in the integration of
pain) [22]. Recent studies have reported that Kinesio taping relieves chronic and acute low back pain [6,
7] and the pain associated with shoulder impingement
syndrome [4]. Thus, the continuous application of SET
results in a reduction in UT tenderness.
The limitations of the current study were that (1)
the inactivity of the UT and the tightness/overactivity
of the scapular depressor muscles such as the lower
trapezius, pectoralis major, and latissimus dorsi muscles were not assessed; (2) shoulder pain scales other
that the PPT were not used; and (3) therapy that did
not involving taping was not studied for comparison
with the effects of SET application. Shoulder depression due to stretching of elevated muscles and hypertrophy of the dominant shoulder in skilled tennis players
was first described by Priest and Nagel, and depression
of the shoulder may simulate apparent scoliosis [23].
However, as seen in the current case, the mechanisms
underlying the correlation between scapular depression
and thoracic scoliosis are unclear in non-athletes, and
additional research is required in this area.
In conclusion, this case shows that SET using Kinesio tape resulted in scapular elevation and reduced
UT tenderness in a patient with scapular depression
syndrome. Future pathophysiologic studies on scapular depression syndrome are necessary for preventing
scapular depression and for obtaining satisfactory therapeutic effects.
Acknowledgments
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No. 2011-0005580).
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