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Fulltext Subacromial Impingement Syndrome of the Shoulder: A Musculoskeletal Disorder or a Medical Myth?

Dhillon KS

Malays Orthop J, 2019 Nov;13(3):1-7.
PMID: 31890103 DOI: 10.5704/MOJ.1911.001

Subacromial impingement syndrome (SAIS) is a commonly diagnosed disorder of the shoulder. Though this disorder has been known for a long time, it remains a poorly understood entity. Over the years several hypotheses have been put forward to describe the pathogenesis of SAIS but no clear explanation has been found. Two mechanisms, the extrinsic and intrinsic mechanism, have been described for the impingement syndrome. The intrinsic mechanism theories which deny the existence of impingement are gaining popularity in recent years. The various shoulder tests used to diagnose SAIS have low specificity with an average of about 50%. Meta-analysis shows that neither the Neer sign nor the Hawkins sign has diagnostic utility for impingement syndrome. Several randomised controlled trials have shown that the outcome of treatment of SAIS by surgery is no better than conservative treatment. Physiotherapy alone can provide good outcome which is comparable to that achieved with surgery without the costs and complications associated with surgery. Since decompression with surgery does not provide any additional benefits as compared to conservative treatment for patients with SAIS, the impingement theory has become antiquated and surgical treatment should have no role in the treatment of such patients. There are calls by some practitioners to abandon the term impingement syndrome and rename it as anterolateral shoulder pain syndrome. It appears that SAIS is a medical myth. There are others who called SAIS as a clinical illusion.

Matched MeSH terms: Shoulder; Shoulder Impingement Syndrome; Shoulder Pain
Fulltext Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report

Rajeev A, Timmons G

Malays Orthop J, 2019 Nov;13(3):66-68.
PMID: 31890113 DOI: 10.5704/MOJ.1911.011

The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.

Matched MeSH terms: Shoulder; Shoulder Fractures
Fulltext Coracoid Process Morphology using 3D-CT Imaging in a Malaysian Population

Imma II, Nizlan NM, Ezamin AR, Yusoff S, Shukur MH

Malays Orthop J, 2017 Jul;11(2):30-35.
PMID: 29021876 MyJurnal DOI: 10.5704/MOJ.1707.012

Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid process which is important in coraco-acromial (CC) ligament reconstruction, to define the average amount of bone available for use in coracoid transfer, and to compare the size of coracoid process based on gender and race, and with findings in previous studies. Materials and Methods: Fifteen pairs of computed tomography (CT) based 3-dimensional models of shoulders of patients aged between 20 to 60 years old were examined. The mean dimensions of coracoid were measured and compared with regards to gender and race. The data were also compared to previously published studies. Results: The mean length of the coracoid process was 37.94 ± 4.30 mm. Male subjects were found to have larger-sized coracoids in all dimensions as compared to female subjects. The mean tip of coracoid dimension overall was 19.99 + 1.93mm length × 10.03 + 1.48mm height × 11.63 + 2.12mm width. The mean base of coracoid dimension was 18.96 + 3.71mm length × 13.84 + 1.76mm width. No significant differences were observed with regards to racial denomination. The overall coracoid size measurements were found to be smaller compared to previous studies done on the Western population. Conclusion: This study may suggest that Malaysians have smaller coracoid dimension compared to Caucasians. The findings further suggest that the incidence of coracoid fracture and implants pull out in Malaysian subjects may be higher.

Matched MeSH terms: Shoulder
Fulltext An 80-year-old woman with left shoulder pain

Khoo SB

Malays Fam Physician, 2010;5(3):139-44.
PMID: 25606206 MyJurnal

This case history illustrates the real life experience and dilemma of an 80-year-old woman in pursuit of medical care for her left shoulder pain. Points for discussion range from clinical features of Pancoast tumor, importance of pain management, good principles of Family Medicine and Palliative care to ethical issues of conspiracy of silence, limited treatment plan and palliative versus curative radiotherapy treatment without a known biopsy report. This paper provides opportunity for analysis of a real complex clinical situation, application of medical knowledge to problem solving in clinical practice and relevant topics for discussions. (For anonymity sake, the names of patient, doctors, general and private hospitals are not mentioned. The aim of this paper is solely for continuous medical education without any intention to ridicule any party).

Matched MeSH terms: Shoulder Pain*
Fulltext A Chinese New Year rash

Keah RSH, Ch'ng KS

Malays Fam Physician, 2013;8(2):62-64.
PMID: 25606287 MyJurnal

A 28-year-old man presented with a chief complaint of rashes all over his body. He had a history of a trip to Langkawi Island, a famous island resort off the west coast of Malaysia, over the Chinese New Year’s weekend. According to him, he had a lot of fun with a group of friends at the sunny beach and the beautiful sea. There were no untoward incidents and they were perfectly well when they returned home after a 2-day trip. On the evening of the second day after his return, he noticed rashes appearing over his body, notably on shoulders and trunk. These rashes were little painful in nature.

Matched MeSH terms: Shoulder
Fulltext Psychophysical and physiological study of asymmetric lifting and lowering task for Malaysian males

Mirta Widia, Siti Zawiah Md Dawal, NukmanYusoff

Malaysian Journal of Public Health Medicine, 2016;16(20):99-105.
MyJurnal

Extensive research has been carried out over the years to determine the maximum acceptable weight that a worker is capable of lifting in a given situation among the Occidental populations in the Europe and US. At present, there is a scarcity of studies in which lifting frequency is used as the measuring variable, especially in developing countries such as Malaysia. Therefore, the objective of this study is to determine the effects of lifting loads on the maximum acceptable frequency limit (MAFL), physiological response (muscle activity) and rating of perceived exertion (RPE) for asymmetric lifting and lowering tasks of Malaysian males.Ten male subjects are recruited in this study and they perform asymmetric lifting and lowering tasks repetitively for 30 minutes. Two lifting loads are considered (1) 1 kg and (2) 5 kg. Each of the subjects adjusts his frequency of lifting using a psychophysical approach. The subjects are instructed to perform the lifting and lowering task as fast as they could over duration of 30 minutes without exhausting themselves or becoming overheated. Electromyography (EMG) signals are recorded from four muscles (Right Erector Spinae (RES), Left Erector Spinae (LES), Right Trapezius p Descendenz (RTD) and Left Trapezius p Descendenz (LTD) and analysed in terms of the normalized MVC during asymmetric lifting and lowering tasks. The ratings of perceived exertion (RPE) for four body parts (arms, lower back, shoulders and entire body) are also collected after the subjects have completed the lifting and lowering task. The mean frequency of the lifting and lowering task obtained from the experiment is 13.41 and 9.66 times/minute for a lifting load of 1 and 5 kg, respectively. The results of the independent sample t-test show that load has a statistically significant effect on the maximum acceptable frequency limit (p < 0.05). However, it is found that even though there is an increase in muscle activity and RPE with an increase in lifting load, there is no significant difference in the overall mean muscle activity and RPE (p > 0.05). The percentage decrease in the maximum acceptable frequency for Malaysian males is higher than the Occidental populations for both of the loads investigated in this study.

Matched MeSH terms: Shoulder
Fulltext Pen and paper based observational method to assess postural problems: a review

Sukadarin, E.H., Deros, B.M., Nawi, N.S.M., Rambely, A.S., Bakar, S.A., Tamrin, S.B.M.

Malaysian Journal of Public Health Medicine, 2016;16(20):78-83.
MyJurnal

Posture is one of the most important factor that need to be considered in any postural analysis. Awkward, extreme,
and repetitive postures can increase the risk of musculoskeletal disorders (MSDs). As observational methods are more
widely used than instrumentation-based methods to assess postural problems, this study reviews and assesses the
scientific literature of observational methods and focused on pen and paper based specifically. In order to identify the
published methods, a list of English or Malay articles dating as far back as 1990 was compiled from PubMed, Science
Direct and Google Scholar. The keywords were ergo*, posture*, method*, observational*, postural problems*, pen and
paper*, posture analysis*, indirect* and macro-ergo*. In addition, a secondary search was also performed using
bibliography of retrieved articles so that additional papers for conducting review and evaluations can be collected. A
total of 121 articles that assessed postural problems in working activities were found. However, after intensive
screening process only 6 articles were selected to be further analyzed. Posture of upper arms/shoulder, lower arms/
elbow, wrist, neck, back/trunk and leg were highlighted in this study. The limitations and the strengths of the
published pen and paper based observational method focusing on those postures were also discussed. The finding of
this review will benefit researchers in the process of understanding unsafe posture in workplace. It could also provide
to researcher on how to improve the current pen and paper based observational method for assessing postural
problems.

Matched MeSH terms: Shoulder
Fulltext Anthropometrics evaluation of children between genders

Hanani Yuhaniz, Asnawi Seraila, Siti Rafedah Abdul Karim, Suhaimi Muhammed, Abdul Hamid Saleh

Malaysian Journal of Public Health Medicine, 2016;16(101):22-25.
MyJurnal

In developing ergonomically sound furniture, there is a need in evaluating anthropometrics from various aspect such as gender differences. The objectives of this study was to evaluate anthropometrics differences between genders of children in Malaysia in order to determine the need in having specified chairs for each gender. Represented by four states in Malaysia, a total of 2400 children were involved in the study. A custom made measurer and an anthropometer were used to measure the subjects. Six body measurements, which are, sitting shoulder height, sitting subscapular height, shoulder breadth, buttock popliteal length, popliteal height and hip width were documented for evaluation. From this study, there were some significant differences on some body parts while other body parts were similar to male and female. Therefore, chairs are needed to be made according to the suitability of both gender.

Matched MeSH terms: Shoulder
Fulltext Mismatch between furniture dimension and anthropometric measures among primary school children in Putrajaya

Adib Asmawi Mohd Yusoff, Irniza Rasdi, Ahmed S. Mahmoud Ben Hameid, Karmegam Karuppiah

Malaysian Journal of Public Health Medicine, 2016;16(10):0-0.
MyJurnal

Ergonomic is important in classroom. Sitting for protracted period in class may lead students to develop musculoskeletal disorders. Their physical health and performance in the class may increase by designing school furniture that match with human body. In Malaysia, there is a lack of ergonomic assessment for school environment especially in urban areas. The aim of this study is to determine the mismatch between the furniture dimension and anthropometric parameters among primary school children in Putrajaya. This is a cross-sectional study which involved 100, Year 1 and Year 6 primary school students randomly selected in Putrajaya. Five anthropometric measurements (popliteal height, buttock popliteal length, elbow height, shoulder height (sitting), hip breadth) as well as five furniture dimensions (seat height, seat depth, seat width, backrest height and seat to desk height) were measured. Instrument used is Martin type anthropometer set, SECA body meter, and SECA weighing scale. Calculation for determining mismatch between the furniture and anthropometric measures were calculated using a standard mismatch formula. There was 100% mismatch for seat height, seat depth, and seat to seat to desk height for Year 1. As for Year 6, mismatch was reported 100% for backrest height and seat to desk height. There were significance difference for parameters of popliteal height between Year 1 and Year 6 and between male and female of Year 1. There was a presence of mismatch between furniture dimension and children anthropometric measurement. Proposed dimension of furniture shows decrease in percentage of mismatch for the most parameter of anthropometric measurement.

Matched MeSH terms: Shoulder
Fulltext Validity test for Simple Ergonomics Risk Assessment (SERA) method

Ezrin Hani Sukadarin, Baba Md Deros, Jaharah A. Ghani, Ahmad Rasdan Ismail, Nur Syazwani Mohd Nawi, Norhidayah Abdull

Malaysian Journal of Public Health Medicine, 2016;16(10):0-0.
MyJurnal

Validity test is important during the development of ergonomics measurement. Failure to conduct validity tests will result in the measurement method being developed to be incapable of providing reliable ergonomics measurements. The objective of this study is to conduct validity test on the simple method ergonomics measurement which was developed. The method named Simple Ergonomics Risks Assessment (SERA). Content validity test and criterion validity test were conducted. The content validity test consists of 6 ergonomics experts who actively provide inputs and positive feedbacks to improve the measurement method being developed. Meanwhile, the criterion validity test involves data collection of complaints on body parts among oil palm workers which were derived from Nordic Musculoskeletal Questionnaire (NMQ) and ergonomics risk assessment scores obtained from SERA. Both findings were tested with the Chi-square test to explore possible relations between the two findings. Results from the test conducted showed that there are significant relations in the scores of neck posture; hip, right and left shoulder, right and left wrists and the right hand associated with fresh fruit bunch (FFB) harvesting activities. In the loose fruits collection, the Chi-square test showed significant relations in the scores of neck posture, hip, right and left shoulders, right wrist, right arm and the left hand. However, there are body parts such as the legs which showed no significant relation. More tests should be conducted to further explore the validity of the method being developed. Findings from both validity tests show that SERA were verified by the experts and tested with validated method so that it is valid to be applied in the future.

Matched MeSH terms: Shoulder
Fulltext Sitting anthropometrics groupings of school children from grades 1 to 5

Hanani Yuhaniz, Asnawi Seraila, Suhaimi Muhammed, Abdul Hamid Saleh

Malaysian Journal of Public Health Medicine, 2016;16(10):0-0.
MyJurnal

This study on anthropometrics of Primary School children from grade 1 to 5 in Peninsular Malaysia involves 2310 students aged seven to eleven years old. The objectives were to analyze the differentiation of anthropometrics between children of grades 1 to 5 and grouping them to suitable levels in which they are appropriate to propose chair dimensions. A multi-stage sampling method was used, and rural and urban areas were also included in providing anthropometric database that represents the whole Peninsular Malaysia population. There were six dimensions measured in this study, which are sitting shoulder, sitting subscapular height, sitting elbow height, hip width, buttock-popliteal length and popliteal height. All the measurements were chosen to represent dimensions needed to construct ergonomic school chair. From the results, ANOVA showed p-values of

Matched MeSH terms: Shoulder
Fulltext A study of work related complaints of arm, neck and shoulder (CANS) among office workers in Selangor and Kuala Lumpur

Erna Faryza, Mohd Suleiman Murad, Syamsul Anwar

Malaysian Journal of Public Health Medicine, 2015;15(2):8-16.
MyJurnal

The computer is well known as one of the important tools in the office that gives a lot of benefits but silently leads to musculoskeletal pain. There are many different kinds of musculoskeletal complaints pain but the most common seen among computer users in developed countries is the complaint of arm, neck and shoulder (CANS). Despite this, definite factors that can be associated with the prevalence of CANS have not been established. This study was conducted to identify the prevalence and factors associated with work-related complaints of arm, neck and shoulder (CANS) among office workers in Selangor and Kuala Lumpur. A survey study design was conducted where 110 (n=110) office workers were recruited from around the Selangor and Kuala Lumpur area for 5 months periods. Participants were required to answer the Maastricht Upper Extremity Questionnaire (MUEQ) and the Level of Ergonomic Knowledge Questionnaire. The study showed the highest percentage of CANS reported was at neck region (53.6% of participants), followed by shoulders with 53.0%. The majority of participants have low level of computer ergonomic awareness where only 19.09% (n=21) from government sector and 10% (n=11) office workers from private sector reported knowledge of ergonomics. Majority of the participants did not have the know-how in implementing correct computer ergonomics. However there was a weak association (r=

Matched MeSH terms: Shoulder
Fulltext Ergonomic design optimization for train seat fit parameters

Teo Chuun, B., Dian Darina Indah, D., Darliana, M.

Malaysian Journal of Public Health Medicine, 2018;18(102):73-78.
MyJurnal

This study is aimed at seat design optimization for high-speed train based on the Malaysians sitting anthropometry
data focusing on seat fit parameters. An analysis of anthropometry data composed of 15 dimensions that are
required in seat design was done with 50 male subjects. These data were collected through direct measuring
methods with standard equipment. According to the Malaysian automotive seat fit parameters, the backrest width,
backrest height, cushion width, and cushion length were established based on these anthropometric dimensions:
interscye breadth (5th percentile female and 95th percentile male), hip breadth (95th percentile female), sitting
shoulder height (5th percentile female), and buttock-popliteal length (5th percentile female), respectively. This
study uses the CATIA software to design and analyse the proposed seat design. The fit parameters proposed for the
new design are seat height, 380mm; cushion width, 450mm; backrest width, 450mm and backrest height, 850mm.
The CATIA human activity analysis (based on Rapid Upper Limb Analysis, RULA) was also executed. From the study,
the new conceptual seat design gives the most optimized fit when compared to the current seat.

Matched MeSH terms: Shoulder
Osteomyelitis in childhood -the natural history documented by radiographs

Singh, H.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):74-76.
MyJurnal

It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.

Matched MeSH terms: Shoulder
Fulltext Prominent hardware post latarjet mimicking shoulder instability symptoms

Raymond DK Yeak, Nasir M Nizlan

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):342-344.
MyJurnal

A 29-year-old man, who was a medical intern presented with history of recurrent shoulder dislocation. Radiographs
and computed tomography imaging revealed a bony bankart lesion with glenoid bone loss of 25% with moderate
Hill- Sachs lesion. Latarjet surgery was performed. At post-operative 8 months, the patient experienced pain and
clicking in the left shoulder while performing cardiopulmonary resuscitation. At post-operative 1 year, magnetic resonance arthrography showed a united coracoid graft and intact posterior labrum. Left shoulder diagnostic arthroscopy and removal of Latarjet screws through a limited anterior deltopectoral approach were performed. The symptoms
pain, clicking and instability sense was caused by either the prominent distal screw or the remnant suture material
from the anchor which resulted in impingement of the infraspinatus muscle. We recommend the use of image intensifier to check on the position and length of the screw at the end of the surgery to avoid this complication

Matched MeSH terms: Shoulder; Shoulder Dislocation; Shoulder Joint
Fulltext Irreparable massive rotator cuff tear in a young patient with recurrent anterior shoulder dislocation

Raymond DK Yeak, Peter T Campbell

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):310-312.
MyJurnal

Combined latissimus dorsi transfer, subscapularis repair and Latarjet surgery is rare and has never been reported. A 35-year-old man with chronic shoulder pain had a long history of instability of his right shoulder. The first episode occurred during a game of touch rugby followed by multiple episodes of subluxation. MRI was done which showed complete tear of the subscapularis anteriorly which was retracted and atrophied indicating a longstanding tear. There was also significant mid substance supraspinatus tendon tear. Patient then underwent two surgeries. The initial sur- gery found the rotator cuff to be irreparable with glenoid bone loss and only acromioplasty with acromioclavicular joint resection were performed. He then had a single stage surgery consisting of latissimus dorsi transfer, Latarjet procedure and subscapularis repair. A two-stage surgery can be avoided, and good results can be obtained provided that the patient undergo correct rehabilitation regime after undergoing a single stage surgery.

Matched MeSH terms: Shoulder; Shoulder Pain
Fulltext Arthroscopic mumford procedure utilizing the anteromedial and neviaser portals – a pilot cadaveric study on neurovascular structures at risk

Nasir Mohd Nizlan, Azfar Rizal Ahmad, Hisham Abdul Rashid, Paisal Hussin, Che Hamzah Fahrudin, Abdullah Arifaizad, et al.

Malaysian Journal of Medicine and Health Sciences, 2016;12(2):16-20.
MyJurnal

Introduction: Degenerative disorder involving the acromioclavicular
joint (ACJ) is quite common especially in the elderly.
One of the surgical modalities of treatment of this disorder is the
Mumford Procedure. Arthroscopic approach is preferred due to
its reduced morbidity and faster post-operative recovery. One
method utilizes the anteromedial and Neviaser portals, which
allow direct and better visualization of the ACJ from the
subacromial space. However, the dangers that may arise from
incision and insertion of instruments through these portals are
not fully understood. This cadaveric study was carried out to
investigate the dangers that can arise from utilization of these
portals and which structures are at risk during this procedure.
Methods: Arthroscopic Mumford procedures were performed
on 5 cadaver shoulders by a single surgeon utilizing the
anteromedial and Neviaser portals. After marking each portals
with methylene blue, dissection of nearby structures were
carried out immediately after each procedure was completed.
Important structures (subclavian artery as well as brachial plexus
and its branches) were identified and the nearest measurements
were made from each portal edges to these structures. Results:
The anteromedial portal was noted to be closest to the
suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal
was noted to be closest also to the SSN at 1.60 cm. The
suprascapular nerve was the structure most at risk during the
Mumford procedure. The anteromedial portal was noted to be
the most risky portal to utilize compared to the Neviaser portal.
Conclusion: Extra precaution needs to be given to the
anteromedial portal while performing an arthroscopic distal
clavicle resection in view of the risk of injuring the
suprascapular nerve of the affected limb.

Matched MeSH terms: Shoulder
Syringomyelia / bulbia presenting as anhidrosis

Choy, Yew Sing, Sinniah, D.

Malaysian Journal of Child Health, 1992;4(1):6-12.
MyJurnal

Reported is the first case of syringomyelia and syringobulbia associated with Arnold Chiari I malformation in a Malaysian child. The initial complaint was that of unilateral anhidrosis of the face. The chief presenting features were dissociated sensory loss, asymmetrical weakness of the left upper limb associated with subluxation of left shoulder and signs of upper motor neurone lesion in the left lower limb. One unusual feature was the presence of vesiculation followed by ulceration of the pinnae of both ears. Magnetic resonance imaging (MRI) of the posterior fossa and cervical and thoracic cord facilitated the diagnosis and was the most useful diagnostic procedure in this child.

Matched MeSH terms: Shoulder
Prolonged writing task: comparison of electromyographic analysis of upper trapezius muscle in subjects with or without neck pain

Leonard JH, Kok KS, Ayiesha R, Das S, Roslizawati N, Vikram M, et al.

Clin Ter, 2010;161(1):29-33.
PMID: 20393675

Work related musculoskeletal disorders represent a serious public health problem as it is a leading cause for disability and absenteeism in workers. The main purpose of the present quasi-experimental study was to compare the muscle activity of the upper trapezius in subjects with neck pain and compare it to those of normal subjects.

Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Shoulder
Fulltext Understanding upper body playing-related musculoskeletal disorders among piano and non-piano players using a photogrammetry

Yuen GK, Clements JB, Ramalingam V, Sundar V

Clin Ter, 2021 Mar 15;172(2):163-167.
PMID: 33763681 DOI: 10.7417/CT.2021.2305

Conclusion: The obtained results conclude piano players are highly prone to the risk of developing PRMSD in the upper body.
Results: The findings showed piano players have a higher NDI, lower CVA, and RSP when compared with the non-piano players at a statistically significant level of p-value <0.05.
Objective: Playing-related musculoskeletal disorders (PRMSD) are a common problem for the pianist. The poor upper body ergonomics influences the natural positioning of the neck and shoulders, which involves forward head posture (FHP) and rounded shoulder posture (RSP). This misaligned position could produce a sensation of pain over the upper body, which affects the piano player and computer users with similar ergonomic posture. Recently, photogrammetry methods are commonly applied in a clinical setting to assess posture. The goal of this research is to compare the upper body playing-related muscu-loskeletal disorders between the piano and the non-piano players by applying photogrammetry.
Materials and Methods: This causal-comparative study includes 70 participants with 35 piano and 35 non-piano players. The participant's FHP was assessed using a digitized photo to record the Craniovertebral angle (CVA) with the support of Kinovea software. Besides, digital Vernier Calliper used to assess the scapular index on the RSP and Neck disability indices (NDI) used to measure neck pain and functional disability of the participants.

Matched MeSH terms: Shoulder/physiopathology

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