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Updated: Aug 5, 2026

Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography
Published on: March 12, 2021
Altered Scapulothoracic Muscle Activity in Overhead Athletes with Rotator Cuff-Related Shoulder Pain: A Systematic
Hio Teng Leong1,2, Ping Liang1,3, Yue Feng1,4
1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China.
Objective:
The systematic review and meta-analysis aimed to compare the electromyographic (EMG) activity of the scapulothoracic muscles in overhead athletes with and without rotator cuff-related shoulder pain (RCRSP).
Design:
PubMed, Web of Science, Scopus and SPORTDiscus databases were searched from inceptions to May 2025. Methodological quality was evaluated using the Joanna Briggs Institute Appraisal Tool. Meta-analyses using random-effects models were conducted. The level of evidence was assessed using the GRADE approach.
Results:
Eleven studies (237 athletes with RCRSP and 205 healthy controls) were included. Very low-certainty evidence showed that athletes with RCRSP demonstrated increased upper trapezius (UT) activity (SMD=0.52; 95% CI: 0.07-0.96), decreased lower trapezius (LT) activity (SMD=-0.52; 95% CI: -0.94 to -0.11), and increased UT/LT ratios (SMD=1.20; 95% CI: -0.03-2.43) compared to healthy athletes. Delayed serratus anterior (SA) activation was also observed (SMD=1.01; 95% CI: 0.42-1.59).
Conclusion:
There is very low-certainty evidence that overhead athletes with RCRSP demonstrate altered scapular muscle activity. These findings may indicate an association rather than a causal relationship. Further high-quality, prospective studies are needed to confirm causal relationships and determine the clinical implications of altered scapular muscle activity in overhead athletes with RCRSP.
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