Scapular dyskinesis and lateral scapular slide tests to assess scapular dyskinesis with chronic neck pain in office workers

Scapular dyskinesis and lateral scapular slide tests to assess scapular dyskinesis with chronic neck pain in office workers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Scapular dyskinesis and lateral scapular slide tests to assess scapular dyskinesis with chronic neck pain in office workers Seong Eun Moon, Young Kyun Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7203202/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Mar, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 14 You are reading this latest preprint version Abstract Background Scapular dyskinesis is associated with shoulder dysfunction and chronic neck pain, particularly in computer-based office workers. Although scapular dyskinesis and lateral scapular slide tests are commonly used in clinical settings, each has limitations when used independently. In addition, only a few studies have examined the clinical relationship between these two testing methods, particularly in individuals with chronic neck pain in whom scapular dysfunction is highly prevalent. This study aimed to examine the relationship between the scapular dyskinesis and lateral scapular slide tests and explore their combined utility in assessing scapular dysfunction in individuals with chronic neck pain. Methods Eighty-three office workers (49 males and 34 females) with chronic neck pain were recruited from three information technology companies in Seoul, Korea. The severity of scapular dyskinesis was assessed using a three-grade scapular dyskinesis test (normal, subtle, and obvious), and the scapulothoracic distance was measured at three arm positions using the lateral scapular slide test. Neck disability index and visual analogue scale scores were also assessed. Results Significant differences were found in the lateral scapular slide test position 2 distance between the scapular dyskinesis test grades in both the dominant (p = 0.0021) and non-dominant arms (p = 0.0195). Individuals with subtle or obvious scapular dyskinesis exhibited significantly greater scapulothoracic distances than those with normal scapular motion. A positive correlation was observed between scapular dyskinesis test severity and lateral scapular slide test position 2 in both arms (dominant, p = 0.040; non-dominant, p = 0.0492). Participants with scapular dyskinesis also had higher neck disability index scores on the dominant side (p = 0.0214), but no significant associations were found with visual analogue scale. Conclusions Combining dynamic scapular dyskinesis and static lateral scapular slide tests provides a more comprehensive evaluation of scapular dysfunction in office workers with chronic neck pain. These findings underscore the need to assess postural alignment and dynamic scapular control in clinical settings. Further research is needed to validate these findings in diverse occupational populations. scapular dyskinesis chronic neck pain computer-based office workers scapular dyskinesis test lateral scapular slide test Figures Figure 1 Background Scapular dyskinesis (SD) is the loss of normal scapular control [ 1 ]. Altered scapular muscle function can cause mechanical dysfunction in the cervical region and neck pain [ 2 ]. However, SD is not an injury and can be found in asymptomatic population [ 3 , 4 ]. The glenohumeral joint is the most mobile joint, and its stability is mostly dependent on soft tissues [ 5 ]. The scapula lies between the shoulder and cervical spine and connects to the neck and shoulder for mobility and stability [ 6 ]. Therefore, the optimum position and function of the scapula are important to serve as an efficient bridge [ 3 ]. SD is related to shoulder dysfunction [ 3 ]; however, recent studies have reported that high rates of SD are associated with chronic neck pain (CNP) [ 7 , 8 ]. Therefore, the assessment of SD is important for treating neck pain and shoulder dysfunction. Prolonged working on a computer can cause poor posture, leading to forward head posture and protracted scapula with an imbalance in periscapular muscle activity [ 9 – 11 ]. Disturbed scapular muscles can cause mechanical dysfunction of the cervical spine, leading to neck pain [ 2 ]. Computer-based office workers with CNP showed a 91.3% of SD prevalence rate [ 8 ], and scapular stabilization exercises decreased pain during CNP [ 12 ]. Karaağaç et al. (2023) recommended evaluating scapular muscle function for CNP due to high prevalence of SD [ 13 ]. The scapular dyskinesis test (SDT) and lateral scapular slide test (LSST) are recommended to measure SD with scapular movement and position [ 14 – 16 ]. Although the tests were reported to be reliable, there are limitations in measuring SD [ 17 ]. SDT relies on clinicians’ subjective visual assessment, and bilateral SD showed a very low prevalence with the LSST compared to that with the SDT [ 8 , 17 ]. The SDT is a clinical assessment used to test SD via observation of scapular movement during shoulder flexion and extension for altered scapular movement [ 1 ]. The reliability of SDT showed moderate to substantial agreement (k = 0.48–0.61) [ 18 ]; however, SDT is a qualitative method, and it depends on the clinical experience of the examiner [ 19 ]. Kibler et al. [ 20 ] recommended a 4-pattern SDT; however, the severity of SD cannot be graded [ 16 ]. The LSST is a quantitative method to examine SD by measuring the distance between the spinous process of the thoracic spine and the inferior angle of the scapula in three different shoulder positions [ 15 ]. The LSST provides objective results using a caliper measure of distance [ 21 ]. However, it only provides a static assessment of scapular position [ 18 ]. Moreover, the LSST assumes that the other side of the scapula is normal [ 22 ]. Therefore, it is limited for assessing SD [ 8 ]. Paraskevopoulos et al. (2019) [ 19 ] suggested qualitative and quantitative measurements to assess and identify improvements in SD. Static and dynamic assessment methods are required to measure SD in clinical settings [ 23 ]. Both the SDT and LSST are widely used owing to their simplicity, noninvasiveness, and accessibility in clinical settings [ 14 , 24 ]. The SDT enables the dynamic evaluation of scapular movement patterns, whereas the LSST provides a quantitative assessment of the scapular position [ 1 , 20 ]. However, few studies have examined the clinical relationship between these two methods, particularly in individuals with CNP in whom scapular dysfunction is highly prevalent. An integrated approach combining dynamic and static assessments may offer a more comprehensive understanding of SD in this population. Therefore, this study aimed to investigate the relationship between the SDT and LSST to measure SD in both the quantitative and qualitative aspects of CNP. Our hypothesis was that increasing the SD grade would increase the distance between the thoracic spine and scapula in CNP. Methods Study population Participants were recruited via email from three informational technology companies in Seoul, Korea, between April and September 2023. The study included office workers aged 20–50 years, experiencing CNP for at least 30 days [ 25 ], with a visual analogue scale (VAS) score of 3.5–8. Those with a history of neck or shoulder fracture or surgery, scoliosis, upper body nerve injuries, or participation in intensive exercise for 6 weeks were excluded [ 26 ]. Participants who were unable to undergo the SDT or LSST were also excluded. G*Power software 3.1 was used to calculate sample size. The expected proportion (p) was set at 0.42 from a previous study showing a 42% prevalence rate of SD in office workers [ 27 ]. The precision (d) was set at 0.1. Considering a dropout rate of 5%, 83 participants were recruited. Informed consent was obtained prior to measurements. The Institutional Review Board of CHA University approved the study (1044308-202303-HR-070-02). The study protocol was conducted in accordance with the principles of the Declaration of Helsinki. Protocol Participants were asked to indicate their age, height, weight, and sex. The three-guide SDT [ 14 ] was used to assess SD, and the LSST was used to measure the distance between the thoracic spine and scapula [ 15 ]. The SDT and LSST were performed by 25- and 15-year-experienced certified athletic trainers, respectively (SDT k = 0.78; LSST k = 0.76) [ 8 ]. All participants were blinded to each other (Fig. 1 ). SDT Participants were asked to grasp dumbbells according to their body weight (1.4 kg for those weighed < 68.1 kg and 2.3 kg for those weighed ≥ 68.1 kg). The participants were then asked to flex their shoulders with their elbow straight to 180° with the thumbs-up position for 3 s and then extend the shoulder to return to the neutral position for 3 s. The test was repeated five times [ 14 ]. The clinician palpated the scapular movement bilaterally to determine the SD grade. No evidence of abnormality in scapular movement was rated as normal, mild abnormality as subtle, and apparent abnormal movement as obvious [ 14 ]. The reliability of the SDT with palpation has been reported to be moderate to substantial (k = 0.49–0.64) [ 18 ]. LSST The participants were asked to stand up, and three different shoulder positions were used to measure the distance between the thoracic spine and inferior angle of the scapula. The first position was the neutral position; the second was with the hands on the hips with the palm facing inferiorly; and the third was with the shoulder at 90° abduction and internal rotation of the thumb to point inferiorly [ 15 ]. A caliper (CAS, Yangju, Korea) was used to measure the distance from the T7 spinous process to the inferior angle of the scapula at all three positions [ 15 , 24 ]. All measurements were taken twice, and the mean was calculated for data analysis. A difference of ≥ 1.5 cm in any of the three positions considered positive for LSST [ 28 ]; however, we only used quantitative distance data for data analysis. The reliability of the LSST is high (intraclass correlation coefficient [ICC] > 0.87–0.92) [ 24 ]. Neck disability index (NDI) Participants were asked to complete the NDI questionnaire. The NDI is widely used for neck pain and disability [ 29 ]. The Korean version of the NDI questionnaire was used, and its reliability was excellent (ICC > 0.93) [ 30 ]. The NDI is measured on a scale of 0 to 100, with a higher NDI score indicating greater neck disability due to neck pain [ 31 ]. VAS for neck pain Participants were asked to determine their eligibility for the study by recording the worst neck pain they had experienced over the past week on a 100-mm horizontal line. They were instructed to rate their pain from 0 (no pain) to 10 (worst pain imaginable) [ 32 ]. Participants with a score of 0 were excluded from the study. Statistical analysis All the statistical analyses were performed using SPSS version 29.0 (IBM Corp., Armonk, NY, USA). The Shapiro–Wilk test was used to test the normal distribution, which was confirmed (p > .05). The dependent variable was the SDT grade (normal, subtle, and obvious), and the distances of LSST positions 1, 2, and 3 were independent variables. One-way analysis of variance was used to compare the LSST distance, age, sex, body weight, neck VAS, and NDI among the SDT grades. The least significant difference post-hoc test was also used. The SDT results were ranked data, and the LSST results were scaled data. Therefore, the Kendall rank correlation was used to analyze the relationship between the SDT and LSST. Pearson’s correlation was used to analyze the results of the LSST, neck VAS, and NDI. Statistical significance was set at p < 0.05. Dominant and non-dominant arms were analyzed separately. Results A total of 83 office workers (49 males and 34 females) with CNP participated in the study. In the dominant shoulders, age (p = .805), sex (p = .507), body weight (p = .576), and neck VAS score (p = .104) were not significantly different among the SDT grades. Height (p = .038) and NDI (p = .021) differed significantly between the groups. The SD group was significantly taller than the normal and subtle SD groups. The normal SD group showed a significantly lower NDI than the subtle and obvious SD groups (Table 1). Table 1. Characteristics of the participants who underwent dominant shoulder SDT D SDT Test (n = 83) Normal Mean (95% CI) Subtle Mean (95% CI) Obvious Mean (95% CI) F p LSD Age, years 33.38 ± 3.75 (29.62–37.13) 32.21 ± 1.85 (30.36–34.07) 32.46 ± 1.66 (30.8–34.13) 0.217 0.805 Sex (M = 1, F = 2) 1.5 ± 0.33 (1.17–1.83) 1.45 ± 0,18 (1.28–1.63)) 1.34 ± 0.16 (1.18–1.5) 0.685 0.507 Height, cm 166.92 ± 4.17 (162.74–171.09) 167.55 ± 2.42 (165.13–169.97) 171.24 ± 2.23 (169.01–173.47)) 3.382 0.038* Normal < Obvious Subtle < Obvious Body weight, kg 68.17 ± 9.92 (58.25–78.08) 65.55 ± 3.23 (62.31–68.78) 68.76 ± 4.96 (63.8–73.73) 0.555 0.576 Neck VAS 2.58 ± 0.86 (1.72–3.44) 3.84 ± .068 (3.15–4.52)) 3.6 ± 0.55 (3.05–4.15) 2.328 0.104 NDI 6.16 ± 2.64 (3.53–8.8) 11.85 ± 2.47 (9.38–14.32)) 10.11 ± 1.78 (8.32–11.89 4.037 0.021* Normal < Subtle Normal < Obvious D, dominant; NDI, neck disability index; VAS, visual analogue scale; SDT, scapular dyskinesis test; M, male; F, female; CI, confidence interval; LSD, least significant difference; * p < 0.05 In the non-dominant shoulder, there were no significant differences in age (p = .213), sex (p = .248), height (p = .433), body weight (p = .615), neck VAS score (p = .801), and NDI (p = .952) among the normal, subtle, and obvious SD groups (Table 2). Table 2. Characteristics of the participants who underwent non-dominant shoulder SDT ND SDT Test (n = 83) Normal Mean (95% CI) Subtle Mean (95% CI) Obvious Mean (95% CI) F p LSD Age, years 32.97 ± 2.92 (30.05–35.89) 33.42 ± 1.82 (31.61–35.24) 31.21 ± 1.69 (29.52–32.9) 1.574 0.213 Sex (M = 1, F = 2) 1.53 ± 0.25 (1.28–1.77) 1.3 ± 0.17 (1.14–1.47) 1.45 ± 0.19 (1.27–1.64) 1.42 0.248 Height, cm 168.16 ± 3.24 (164.92–171.4) 170.36 ± 2.68 (167.68–173.05) 168.45 ± 2.37 (166.08–170.82) 0.846 0.433 Body weight, kg 66.89 ± 5.75 (61.14–72.65) 69.09 ± 5.16 (63.93–74.25) 65.9 ± 4.47 (61.43–70.38) 0.489 0.615 Neck VAS 3.59 ± 0.99 (2.6–4.58) 3.68 ± 0.69 (2.99–4.36) 3.38 ± 0.51 (2.87–3.89) 0.222 0.801 NDI 9.89 ± 3.22 (6.67–13.12) 10.45 ± 2.38 (8.07–12.84) 10.19 ± 1.96 (8.23–12.15) 0.049 0.952 ND, non-dominant; NDI, neck disability index; VAS, visual analogue scale; SDT, scapular dyskinesis test; M, male; F, female; CI, confidence interval; LSD, least significant difference In the dominant shoulders, LSST position 2 showed a significant difference in length (p = .002). The obvious SD group exhibited a longer distance than the subtle SD group. There were no significant differences in the LSST positions 1 and 3 among the SDT groups (Table 3). Table 3. LSST length with dominant shoulder SDT D SDT (n = 83) SDT Normal Mean (95% CI) SDT Subtle Mean (95% CI) SDT Obvious Mean (95% CI) F p LSD LSST 1, mm 88.5 ± 6.09 (82.41–94.59) 83.46 ± 3.81 (79.66–87.27) 90.18 ± 4.43 (85.75–94.61) 2.865 0.062 LSST 2, mm 93.77 ± 5.67 (88.1–99.44) 90.21 ± 3.36 (86.85–93.57) 98.89 ± 3.56 (95.33–102.45) 6.645 0.002* Subtle < Obvious LSST 3, mm 92.98 ± 6.8 (86.17–99.78) 92.01 ± 4.77 (87.25–96.78) 98.25 ± 4.39 (93.86–102.63) 2.186 0.119 D, dominant; CI, confidence interval; SDT, scapular dyskinesis test; LSST, lateral scapular slide test; LSD, least significance difference; * p < 0.05 In the non-dominant shoulder, LSST position 2 showed a significant difference in length (p = .019). The subtle and obvious SD groups exhibited longer distances than the normal SD group. There were no significant differences in LSST positions 1 and 3 among the SDT groups (Table 4). Table 4. LSST length with non-dominant shoulder SDT ND SD (n = 83) SDT Normal Mean (95% CI) SDT Subtle Mean (95% CI) SDT Obvious Mean (95% CI) F p LSD LSST 1, mm 82.54 ± 4.95 (77.59–87.49) 86.58 ± 4.18 (82.4–90.76) 86.06 ± 4.13 (81.93–90.19) 0.845 0.433 LSST 2, mm 86.63 ± 3.68 (82.95–90.31) 93.85 ± 4.13 (89.72–97.98) 93.84 ± 2.99 (90.85–96.83) 4.136 0.019* Normal < Subtle Normal < Obvious LSST 3, mm 89.75 ± 5.53 (84.22–95.28) 91.37 ± 4.26 (87.11–95.62) 95.02 ± 5.12 (89.9–100.14) 1.191 0.309 ND, non-dominant; SDT, scapular dyskinesis test; LSST, lateral scapular slide test; LSD, least significance difference; * p < 0.05 Significant positive correlations were found between the SDT and LSST position 2 (r = 0.22, p = .04) in the dominant and non-dominant (r = 0.21, p = .049) shoulders. No significant correlation was found between the SDT and LSST positions 1 and 3 in the dominant and non-dominant shoulders (Table 5 ). Table 5 Correlation between the SDT and LSST Scapular dyskinesis test Correlation p SDT D / LSST 1 D 0.1 0.36 SDT D / LSST 2 D 0.22 0.04* SDT D / LSST 3 D 0.16 0.15 SDT ND / LSST 1 ND 0.07 0.52 SDT ND / LSST 2 ND 0.21 0.04* SDT ND / LSST 3 ND 0.13 0.23 D, dominant; ND, non-dominant; SDT, scapular dyskinesis test; LSST, lateral scapular slide test; * p < 0.05 A significant negative correlation was identified between LSST position 3 and neck VAS scores in the non-dominant group (p = .04). However, there was no significant correlation between other LSST positions and VAS/NDI (Table 6 ). Table 6 Correlation between the LSST and neck VAS score and NDI Lateral scapular slide test Correlation coefficient 95% CI t score p-value Dominant arm LSST1-N.VAS -0.09 (-0.3–0.13) -0.769 0.44 LSST2-N.VAS 0 (-0.22–0.21) -0.013 0.99 LSST3-N.VAS -0.12 (-0.32–0.1) -1.049 0.3 LSST1-NDI 0 (-0.22–0.21) -0.0189 0.98 LSST2-NDI -0.03 (-0.24–0.19) -0.23 0.82 LSST3-NDI -0.04 (-0.25–0.18) -0.35 0.73 Non-dominant arm LSST1-N.VAS -0.12 (-0.33–0.1) -1.1027 0.27 LSST2-N.VAS -0.07 (-0.28–0.15) -0.645 0.52 LSST3-N.VAS -0.22 (-0.41–0) -1.9995 0.04 * LSST1-NDI -0.02 (-0.23–0.2) -0.04 0.89 LSST2-NDI -0.13 (-0.34–0.09) -1.1686 0.25 LSST3-NDI -0.16 (-0.36–0.06) -1.4132 0.16 LSST, lateral scapular slide test; N.VAS, neck visual analogue scale; NDI, neck disability index; CI, confidence interval; * p < 0.05 Discussion The SD grades of office workers with CNP were assessed using the SDT and LSST. The SDT is a dynamic qualitative method, whereas the LSST is a static quantitative method [ 15 , 19 ]. The relationship between these two measures was analyzed to understand the SD grade and the distance between the thoracic spine and inferior angle of the scapula. This study aimed to explore the clinical advantages of combining SDT and LSST in office workers with CNP. Subtle and obvious SD demonstrated significantly greater scapulothoracic distances in the LSST position. These findings are consistent with previous research [ 8 ]. Kibler (1998) reported that LSST positions 1 and 2 were performed with the shoulder relaxed, inducing minimal muscle activation, whereas position 3 was performed with activated scapular stabilizers with hands unsupported [ 15 ], increasing the likelihood of scapular control. The LSST assesses the bilateral distance between the thoracic spine and scapular inferior angle in three different shoulder positions, and a side-to-side difference > 1.5 cm is used to identify SD [ 28 ]. This approach assumed that the opposite side of the shoulder was normal [ 22 ]. However, a previous study found that 72.48% of computer programmers exhibit bilateral SD [ 8 ]. Moreover, the SD rates were significantly higher with the SDT (89.9%) than with the LSST (23%) in the same population [ 8 ]. The LSST is a static posture measurement; therefore, scapular motion cannot be evaluated [ 18 , 33 ]. SD should be evaluated based on dynamic movement patterns [ 34 ], Although computed tomography has been proposed as a highly accurate tool for assessing scapular position [ 35 , 36 ], limitations in cost and accessibility may hinder its practical application, and similar to the LSST, it is also a static posture measurement [ 37 ]. Nevertheless, the LSST demonstrates high inter-rater reliability (ICC > 0.87) [ 24 ] and serves as a simple yet reliable method for quantitative assessment using basic tools such as a tape measure or caliper [ 20 ]. Therefore, combining the SDT (qualitative method) and LSST (quantitative method) offers a practical and clinically feasible approach for SD evaluation [ 23 ] in CNP with SD. A positive correlation was observed between the SDT grades and LSST position 2 distance in both the dominant (p = .040) and non-dominant (p = .049) shoulders. These findings suggest that severe SD grades in office workers with CNP are associated with increased scapulothoracic distance in LSST position 2. This may reflect a loss of control over scapular positioning under static and dynamic conditions, resulting in scapular protraction [ 38 ]. Yildiz et al. (2019) reported a significant reduction in middle trapezius activity in SD compared with that in normal scapular movement [ 7 ]. Scapular protraction with SD increases the distance between the scapula and thoracic spine [ 38 , 39 ]. This may be related to the weakness and lengthening of the middle trapezius and rhomboid muscles. SD involves an excessively protracted scapula at rest or during arm movement [ 3 ]. The protracted position is characterized by anterior displacement of the scapula over the thoracic wall [ 40 ], which is primarily facilitated by the serratus anterior and pectoralis major and minor [ 41 ]. The serratus punch is commonly used to enhance scapular stabilization because it maximally activates and shortens the serratus anterior [ 42 ]. Previous studies have reported that SD is frequently associated with weakness in the serratus anterior [ 43 , 44 ]. However, the findings of our study are in contrast to those of previous studies. Serratus anterior activation-focused exercises may increase the scapulothoracic distance with SD. Scapular stabilization relies on coupled forces of the trapezius, serratus anterior, and rhomboid muscles [ 45 ]. The rhomboid muscle particularly contributes to the mediolateral control of scapular motion [ 3 ]. Chaudhary et al. (2024) suggested that an effective shoulder SD rehabilitation emphasized rhomboid-focused training [ 46 ]. Based on the present findings, office workers with CNP and more severe SD showed a greater distance between the scapula and thoracic spine. Further research is warranted to evaluate the effects of rhomboid-and middle trapezius-centered interventions to treat SD in office workers with CNP. A significant difference was found in the NDI scores between individuals with and without SD, as identified by the SDT on the dominant arm (p = 0.021). Office workers with CNP who exhibited subtle or obvious SD had significantly higher NDI scores than those with normal scapular motion. Jensen et al. (1999) suggested that the frequent use of a mouse with a dominant arm may reduce the resting time in the upper trapezius [ 47 ]. The altered resting scapular posture on the dominant side, characterized by greater internal rotation and anterior tilt than on the non-dominant side [ 22 ], may contribute to altered scapular kinematics. Moreover, no significant correlations were found between the LSST distances on the dominant side and the neck VAS or NDI scores. Similarly, no significant associations were observed between the SDT on the non-dominant side and neck VAS or NDI. The SDT was significantly associated with NDI, which may be related to the functional impairment linked to dynamic scapular control [ 14 , 31 ]. By contrast, the LSST showed a significant association with the neck VAS score, which may be related to posture-related pain [ 48 ]. These findings highlighted the value of using both assessments for a more comprehensive evaluation. A significant correlation was observed between LSST Position 3 and the neck VAS score on the non-dominant side (p = 0.049) (Table 6 ). This may indicate that greater neuromuscular demand on the non-dominant side due to relatively lower motor control leads to fatigue and contributes to neck pain [ 49 ]. Altered muscle activation patterns may lead to abnormal scapular kinematics, resulting in scapular protraction, which increases the distance between the thoracic spine and scapula [ 1 ]. In a previous LSST-based study involving 36 office workers, the mean NDI score was 4.78 ± 3.2 [ 27 ]. By contrast, the present study, which included 83 participants and utilized both the SDT and LSST, revealed higher average NDI scores (dominant normal, 6.16 ± 2.64; subtle, 11.85 ± 2.47; and obvious, 10.11 ± 1.78; non-dominant normal, 9.89 ± 3.22; subtle, 10.45 ± 2.38; and obvious, 10.19 ± 1.96). Interestingly, these findings suggest that the non-dominant side, which is traditionally considered less loaded, can nonetheless exhibit meaningful functional impairments and perceived disability. This highlights the importance of bilateral evaluation for comprehensively assessing SD and guiding tailored interventions for office workers. The SDT measures scapular dynamic stability, which requires the coordinated activation of the upper trapezius, serratus anterior, lower trapezius, and rhomboids [ 34 ]. By contrast, the LSST measures static positional differences [ 21 ] and may not fully reflect neuromuscular control or functional scapular movements [ 24 ]. While the SD in athletes is often associated with repetitive activity [ 50 , 51 ], office workers may develop SD owing to prolonged sitting, repetitive postures, and poor ergonomic conditions [ 52 ]. In this population, CNP is frequently accompanied by tightness of the upper trapezius, pectoralis minor, and levator scapulae [ 26 ], all of which are directly attached to the scapula and can alter its movement, potentially leading to SD [ 1 ]. Therefore, office workers not only maintain prolonged sitting postures but also experience concomitant muscular tension and imbalances involving the muscles attached to the scapula. The combined use of the SDT and LSST may serve as a more comprehensive and appropriate approach for evaluating SD in this population. A significant association was observed between SDT severity on the dominant arm and height (p = 0.38), which is consistent with previous studies suggesting that anthropometric factors may influence upper-extremity kinematic [ 53 ]. By contrast, no significant association between SDT severity and height was found on the non-dominant side, which may reflect the generally lower functional demand and habitual use of that limb. No significant differences were found in age, sex, body weight, or neck VAS scores among the normal, subtle, and obvious SD groups. Although female office workers are known to experience neck pain more frequently than males [ 54 ], our findings did not reveal significant sex differences in the neck VAS scores among individuals with SD. In athletes, repetitive overhead motions and muscle fatigue increase the prevalence of SD [ 55 , 56 ]. By contrast, computer-based office workers are more likely to adopt prolonged postures involving a forward head position and rounded shoulders, which can alter scapular kinematics and muscle activation, thereby contributing to the development of SD [ 57 ]. Unlike athletes, office workers do not typically perform overhead activities, suggesting that reliance on the SDT alone may be insufficient for identifying SD in this population. Therefore, combining the static quantitative assessment of LSST position 2 with dynamic qualitative SDT may provide a more comprehensive evaluation of SD by accounting for both resting posture and movement characteristics in office workers with CNP. Further research is needed to explore the underlying mechanisms of SD in computer-based office workers and develop effective interventions that address both static and dynamic contributors. This study has several limitations. Participants were limited to office workers with CNP. Therefore, the current findings may not apply to other populations such as athletes or individuals with shoulder pathologies. Additionally, the SDT has been used to classify SD, although there is currently no established gold standard for its diagnosis. The three-grade classification system (normal, subtle, and obvious) used in this study demonstrated good reliability (ICC = 0.86) [ 58 ]; however, its interpretation still depends on the evaluator. Furthermore, individual anthropometric differences were not controlled through normalization by height, and personal factors such as occupational tasks, previous sports participation, and sex-specific differences were not accounted for. Finally, all participants were recruited from Seoul, South Korea, which may limit the external validity of the findings to other regions or populations. Conclusion By combining static and dynamic assessments, the LSST and SDT can provide a more comprehensive understanding of SD in office workers with CNP. A significant association was observed between the SD grade and scapulothoracic distance, particularly in LSST position 2, suggesting that an increased SD grade is linked to scapular protraction in office workers with CNP. Additionally, individuals with SD reported higher levels of neck disability. These findings highlight the importance of evaluating both static postural alignment and dynamic scapular control in clinical assessments. However, as the participants in this study were limited to office workers with CNP, further research is required to examine populations with different occupational demands. Abbreviations SD, scapular dyskinesis CNP, chronic neck pain LSST, lateral scapular slide test VAS, visual analogue scale NDI, neck disability index ICC, intraclass correlation coefficient Declarations Ethics approval and consent to participate : The Institutional Review Board of CHA University approved the study (1044308-202303-HR-070-02), and informed consent was obtained from all participants. Consent for publication: Not applicable Availability of data and materials All data generated and analyzed during this study are included in this published article. Competing interests The authors declare no competing interests. Funding There is no funding available. Authors' contributions YK led on study design, and SM conducted all literature searches, analyzed all data. YK reviewed the analysis of literature. SM drafted the initial manuscript, and YK reviewed the manuscript. Acknowledgements We thank the department of medicine, CHA University for the contributions to the development process. Authors' information 1. Department of Medicine, Graduate School, CHA University, Seongnam-si 13503, Republic of Korea References Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: The 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013;47:877–85. Castelein B, Cools A, Parlevliet T, Cagnie B. Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated? A case-control study with surface and fine-wire EMG. J Electromyogr Kinesiol. 2016;31:136–43. Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012;20:364–72. Salamh PA, Hanney WJ, Boles T, Holmes D, McMillan A, Wagner A, et al. Is it time to normalize scapular dyskinesis? The incidence of scapular dyskinesis in those with and without symptoms: A systematic review of the literature. Int J Sports Phys Ther. 2023;V18:558–76. Ma R, Brimmo OA, Li X, Colbert L. Current concepts in rehabilitation for traumatic anterior shoulder instability. Curr Rev Musculoskelet Med. 2017;10:499–506. Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48:692–7. Yildiz TI, Cools A, Duzgun I. Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain. Clin Biomech (Bristol). 2019;70:97–106. Moon SE, Kim YK. Neck and shoulder pain with scapular dyskinesis in computer office workers. Med (Kaunas). 2023;59:2159. Cagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D. Individual and work related risk factors for neck pain among office workers: A cross sectional study. Eur Spine J. 2007;16:679–86. Szeto GP, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—1: Neck and shoulder muscle recruitment patterns. Man Ther. 2005;10:270–80. Szeto GP, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—2: Neck and shoulder kinematics. Man Ther. 2005;10:281–91. Özdemir F, Toy Ş, Kızılay F, Avcı ZT, Altay Z, Çolak C. Effects of scapular stabilization exercises in patients of chronic neck pain with scapular dyskinesis: A quasi-experimental study. Turk J Phys Med Rehabil. 2021;67:77–83. Karaağaç A, Arslan SA, Keskin ED. Assessment of pain, scapulothoracic muscle strength, endurance and scapular dyskinesis in individuals with and without nonspecific chronic neck pain: A cross-sectional study. J Bodyw Mov Ther. 2023;35:261–7. McClure P, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis, part 1: Reliability. J Athl Train. 2009;44:160–4. Ben Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26:325–37. Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25:1240–8. O'Connor S, McCaffrey N, Whyte E, Moran K. The development and reliability of a simple field-based screening tool to assess for scapular dyskinesis. J Sport Rehabil. 2016;25:2015–0054. Paraskevopoulos E, Papandreou M, Gliatis J. Reliability of assessment methods for scapular dyskinesis in asymptomatic subjects: A systematic review. Acta Orthop Traumatol Turc. 2020;54:546–56. Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: A reliability study. J Shoulder Elb Surg. 2002;11:550–6. Curtis T, Roush JR. The lateral scapular slide test: A reliability study of males with and without shoulder pathology. N Am J Sports Phys Ther. 2006;1:140–6. Huang T-S, Huang H-Y, Wang T-G, Tsai Y-S, Lin J-J. Comprehensive classification test of scapular dyskinesis: A reliability study. Man Ther. 2015;20:427–32. Oyama S, Myers JB, Wassinger CA, Daniel Ricci R, Lephart SM. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008;43:565–70. Larsen CM, Søgaard K, Eshoj H, Ingwersen K, Juul-Kristensen B. Clinical assessment methods for scapular position and function. An inter-rater reliability study. Physiother Theor Pract. 2020;36:1399–420. Shadmehr A, Bagheri H, Ansari NN, Sarafraz H. The reliability measurements of lateral scapular slide test at three different degrees of shoulder joint abduction. Br J Sports Med. 2010;44:289–93. Fejer R. Categorising the severity of neck pain. In: Categorising Severity Neck Pain. 2006;2006. Vongsirinavarat M, Wangbunkhong S, Sakulsriprasert P, Petviset H. Prevalence of scapular dyskinesis in office workers with neck and scapular pain. Int J Occup Saf Ergon. 2023;29:50–5. Depreli O, Ender Angın E, Yatar I, Kirmizigil B, Malkoc M. Scapular dyskinesis and work-related pain in office workers-a pilot study. Int J Phys Ther Rehab. 2016;2:2. Ozunlu N, Tekeli H, Baltaci G. Lateral scapular slide test and scapular mobility in volleyball players. J Athl Train. 2011;46:438–44. Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for measurement of functional outcome for cervical pain or dysfunction: A systematic review. Spine. 2002;27:515–22. Song K-J, Choi B-W, Choi B-R, Seo G-B. Cross-cultural adaptation and validation of the Korean version of the neck disability index. Spine. 2010;35:E1045–9. Howell ER. The association between neck pain, the Neck Disability Index and cervical ranges of motion: A narrative review. J Can Chiropr Assoc. 2011;55:211–21. Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175–84. Tate AR, McClure P, Kareha S, Irwin D, Barbe MF. A clinical method for identifying scapular dyskinesis, part 2: Validity. J Athl Train. 2009;44:165–73. Kibler WB, Sciascia A. Current concepts: Scapular dyskinesis. Br J Sports Med. 2010;44:300–5. Park J-Y, Hwang J-T, Kim K-M, Makkar D, Moon SG, Han K-J. How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography-a new diagnostic modality. J Shoulder Elb Surg. 2013;22:1084–91. Park J-Y, Hwang J-T, Oh K-S, Kim S-J, Kim NR, Cha M-J. Revisit to scapular dyskinesis: Three-dimensional wing computed tomography in prone position. J Shoulder Elb Surg. 2014;23:821–8. Jayasinghe GS. Scapula dyskinesis: A review of current concepts and evaluation of assessment tools. Curr Sports Med Rep. 2018;17:338–46. Kibler WB, Sciascia A. Evaluation and management of scapular dyskinesis in overhead athletes. Curr Rev Musculoskelet Med. 2019;12:515–26. Ben Kibler WB, Lockhart JW, Cromwell R, Sciascia A. Managing scapular dyskinesis. Phys Med Rehabil Clin N Am. 2023;34:427–51. Paine R, Voight ML. The role of the scapula. Int J Sports Phys Ther. 2013;8:617–29. Jaggi A, Alexander S. Suppl. 6, M13: Rehabilitation for shoulder instability–current approaches. Open Orthop J. 2017;11:957–71. Castelein B, Cagnie B, Parlevliet T, Cools A. Serratus anterior or pectoralis minor: Which muscle has the upper hand during protraction exercises? Man Ther. 2016;22:158–64. Huang T-S, Ou H-L, Huang C-Y, Lin J-J. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elb Surg. 2015;24:1227–34. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641–61. Petersen SA. Posterior shoulder instability. Orthop Clin North Am. 2000;31:263–74. Chaudhary A, Sharma A, Zaidi S, Rizvi M. Transforming Rehabilitation for Scapular Dyskinesia: The role of Modified Robbery Exercises in enhancing Muscle Function, reducing Disability, and improving Quality of Life. IJOPRP. 2024;3:161–75. Jensen C, Finsen L, Hansen K, Christensen H. Upper trapezius muscle activity patterns during repetitive manual material handling and work with a computer mouse. J Electromyogr Kinesiol. 1999;9:317–25. Kim S-R, Kang M-H, Bahng S-Y, An J-K, Lee J-Y, Park S-Y, et al. Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain. J Phys Ther Sci. 2016;28:1508–10. Poirier G, Papaxanthis C, Mourey F, Lebigre M, Gaveau J. Muscle effort is best minimized by the right-dominant arm in the gravity field. J Neurophysiol. 2022;127:1117–26. Jeong JH, Kim YK. Association of scapular dyskinesis with neck and shoulder function and training period in Brazilian Ju-Jitsu athletes. Med (Kaunas). 2023;59:1481. Jung J. Scapular dyskinesis in elite boxers with neck disa; 2021. Sree SD. To evaluate scapulohumeral rhythm in scapular dyskinesia in software professionals with neck pain. Indian J Physiother Occup Ther 2020;14. Torabi TP, Juul-Kristensen B, Dam M, Zebis MK, van den Tillaar R, Bencke J. Comparison of shoulder kinematics and muscle activation of female elite handball players with and without pain—An explorative cross-sectional study. Front Sports Act Living. 2022;4:868263. Korhonen T, Ketola R, Toivonen R, Luukkonen R, Häkkänen M, Viikari-Juntura E. Work related and individual predictors for incident neck pain among office employees working with video display units. Occup Environ Med. 2003;60:475–82. Ebaugh DD, McClure PW, Karduna AR. Effects of shoulder muscle fatigue caused by repetitive overhead activities on scapulothoracic and glenohumeral kinematics. J Electromyogr Kinesiol. 2006;16:224–35. Andres J, Painter PJ, McIlvain G, Timmons MK. The effect of repeated shoulder motion on scapular dyskinesis in army ROTC cadets. Mil Med. 2020;185:e811–7. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20:701–9. Rossi DM, Pedroni CR, Martins J, de Oliveira AS. Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLoS ONE. 2017;12:e0181518. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Mar, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 14 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviews received at journal 11 Oct, 2025 Reviews received at journal 26 Sep, 2025 Reviews received at journal 23 Sep, 2025 Reviewers agreed at journal 21 Sep, 2025 Reviewers agreed at journal 21 Sep, 2025 Reviewers agreed at journal 19 Sep, 2025 Reviewers agreed at journal 19 Sep, 2025 Reviewers invited by journal 19 Sep, 2025 Editor invited by journal 18 Sep, 2025 Editor assigned by journal 06 Aug, 2025 Submission checks completed at journal 06 Aug, 2025 First submitted to journal 24 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7203202","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522020394,"identity":"1f33e6d9-0ee3-4229-9e09-e8b93580e360","order_by":0,"name":"Seong Eun Moon","email":"","orcid":"","institution":"CHA University","correspondingAuthor":false,"prefix":"","firstName":"Seong","middleName":"Eun","lastName":"Moon","suffix":""},{"id":522020395,"identity":"d1b55109-82ef-4958-9b53-f2a3415c6d59","order_by":1,"name":"Young Kyun Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie3PMUoDQRTG8S8E3jYv2XaWiOsRZgloEzzLBGGqtQ9YZKuxyQHiLTzC4IO1mWBrSBMQUtnZWIgowcZmdu0s5l8+5gffAKnUf4wJHgt1SllDP5deJMymOfs/EAycnd+tTU+iQzt/eCYZ3G9fDvt3XJbgzT5ONs5LzTLUO3tRrXBVNaNbHSdPWSO1EtK7mhRjaJBTx7Aj0cJ6G6j4wLIHOQ4zVhVrpglDDEYuTorQGqn9TOdszycn+rFy3MbJONjp2/WnWrpMDsXr4qb8tnFy5n/vBDp+ApRN14tUKpVKfQFJw0NbE//B3QAAAABJRU5ErkJggg==","orcid":"","institution":"CHA University","correspondingAuthor":true,"prefix":"","firstName":"Young","middleName":"Kyun","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2025-07-24 08:28:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7203202/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7203202/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-026-09718-9","type":"published","date":"2026-03-10T15:57:45+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92532041,"identity":"ed72cd5d-d53b-4cb9-a9b7-26b979a140d6","added_by":"auto","created_at":"2025-09-30 16:45:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":284469,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/f1175f6b9e079c5d58d0d44c.docx"},{"id":92532042,"identity":"56908c7a-0895-4b31-9f8c-4214af1088c4","added_by":"auto","created_at":"2025-09-30 16:45:48","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63210,"visible":true,"origin":"","legend":"","description":"","filename":"sdtlsst250717yk12.docx","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/2069cd5e28801c704d790bd6.docx"},{"id":92530436,"identity":"b2d867e5-d152-41c5-851b-ab3c99a6a8de","added_by":"auto","created_at":"2025-09-30 16:37:48","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18381,"visible":true,"origin":"","legend":"","description":"","filename":"Table6.docx","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/64afe4f3d9f0d60ab772a927.docx"},{"id":92532040,"identity":"b539cadd-143e-472d-8e4d-ae3461cb44d4","added_by":"auto","created_at":"2025-09-30 16:45:48","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5197,"visible":true,"origin":"","legend":"","description":"","filename":"ff28c9d4d3ab400c9688fde7ba6f0757.json","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/63f5fd3db6efee3bafe37139.json"},{"id":92530439,"identity":"4946256e-6abc-4add-9de6-ab200589c558","added_by":"auto","created_at":"2025-09-30 16:37:48","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":161160,"visible":true,"origin":"","legend":"","description":"","filename":"ff28c9d4d3ab400c9688fde7ba6f07571enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/57ec151a5a2d3831525c64ec.xml"},{"id":92530434,"identity":"946db727-8c50-466e-8dbc-0dbd005ecde1","added_by":"auto","created_at":"2025-09-30 16:37:48","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":52479,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/fa14571acef3d8733eeb8f68.png"},{"id":92530440,"identity":"010788cc-5bb1-47dd-9e51-30d0739d26f5","added_by":"auto","created_at":"2025-09-30 16:37:48","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164791,"visible":true,"origin":"","legend":"","description":"","filename":"ff28c9d4d3ab400c9688fde7ba6f07571structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/3838c89f2aeacf22e40a6f70.xml"},{"id":92530437,"identity":"7cf89fff-e5a4-46b6-8452-e316d6129d79","added_by":"auto","created_at":"2025-09-30 16:37:48","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":173962,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/6b76bd421a1c45ad3943750f.html"},{"id":92530432,"identity":"dd489839-c11c-44c1-8369-358fee3607b0","added_by":"auto","created_at":"2025-09-30 16:37:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":275744,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of measurement. SDT, scapular dyskinesis test; LSST, lateral scapular slide test; NDI, neck disability index; VAS, visual analogue scale\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/eb165d9c48a3dc316d818c4e.png"},{"id":104739307,"identity":"3dd7fa0f-cb52-4597-8175-86148a7dc193","added_by":"auto","created_at":"2026-03-16 16:01:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1172397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7203202/v1/a3dbaede-7778-4009-aba8-66113165d2e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Scapular dyskinesis and lateral scapular slide tests to assess scapular dyskinesis with chronic neck pain in office workers","fulltext":[{"header":"Background","content":"\u003cp\u003eScapular dyskinesis (SD) is the loss of normal scapular control [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Altered scapular muscle function can cause mechanical dysfunction in the cervical region and neck pain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, SD is not an injury and can be found in asymptomatic population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The glenohumeral joint is the most mobile joint, and its stability is mostly dependent on soft tissues [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The scapula lies between the shoulder and cervical spine and connects to the neck and shoulder for mobility and stability [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, the optimum position and function of the scapula are important to serve as an efficient bridge [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. SD is related to shoulder dysfunction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]; however, recent studies have reported that high rates of SD are associated with chronic neck pain (CNP) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, the assessment of SD is important for treating neck pain and shoulder dysfunction.\u003c/p\u003e\u003cp\u003eProlonged working on a computer can cause poor posture, leading to forward head posture and protracted scapula with an imbalance in periscapular muscle activity [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Disturbed scapular muscles can cause mechanical dysfunction of the cervical spine, leading to neck pain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Computer-based office workers with CNP showed a 91.3% of SD prevalence rate [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and scapular stabilization exercises decreased pain during CNP [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Karaağa\u0026ccedil; et al. (2023) recommended evaluating scapular muscle function for CNP due to high prevalence of SD [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The scapular dyskinesis test (SDT) and lateral scapular slide test (LSST) are recommended to measure SD with scapular movement and position [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although the tests were reported to be reliable, there are limitations in measuring SD [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. SDT relies on clinicians\u0026rsquo; subjective visual assessment, and bilateral SD showed a very low prevalence with the LSST compared to that with the SDT [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe SDT is a clinical assessment used to test SD via observation of scapular movement during shoulder flexion and extension for altered scapular movement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The reliability of SDT showed moderate to substantial agreement (k\u0026thinsp;=\u0026thinsp;0.48\u0026ndash;0.61) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; however, SDT is a qualitative method, and it depends on the clinical experience of the examiner [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Kibler et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] recommended a 4-pattern SDT; however, the severity of SD cannot be graded [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The LSST is a quantitative method to examine SD by measuring the distance between the spinous process of the thoracic spine and the inferior angle of the scapula in three different shoulder positions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The LSST provides objective results using a caliper measure of distance [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, it only provides a static assessment of scapular position [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Moreover, the LSST assumes that the other side of the scapula is normal [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, it is limited for assessing SD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Paraskevopoulos et al. (2019) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] suggested qualitative and quantitative measurements to assess and identify improvements in SD. Static and dynamic assessment methods are required to measure SD in clinical settings [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBoth the SDT and LSST are widely used owing to their simplicity, noninvasiveness, and accessibility in clinical settings [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The SDT enables the dynamic evaluation of scapular movement patterns, whereas the LSST provides a quantitative assessment of the scapular position [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, few studies have examined the clinical relationship between these two methods, particularly in individuals with CNP in whom scapular dysfunction is highly prevalent. An integrated approach combining dynamic and static assessments may offer a more comprehensive understanding of SD in this population. Therefore, this study aimed to investigate the relationship between the SDT and LSST to measure SD in both the quantitative and qualitative aspects of CNP. Our hypothesis was that increasing the SD grade would increase the distance between the thoracic spine and scapula in CNP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy population\u003c/p\u003e\u003cp\u003eParticipants were recruited via email from three informational technology companies in Seoul, Korea, between April and September 2023. The study included office workers aged 20\u0026ndash;50 years, experiencing CNP for at least 30 days [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], with a visual analogue scale (VAS) score of 3.5\u0026ndash;8. Those with a history of neck or shoulder fracture or surgery, scoliosis, upper body nerve injuries, or participation in intensive exercise for 6 weeks were excluded [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Participants who were unable to undergo the SDT or LSST were also excluded. G*Power software 3.1 was used to calculate sample size. The expected proportion (p) was set at 0.42 from a previous study showing a 42% prevalence rate of SD in office workers [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The precision (d) was set at 0.1. Considering a dropout rate of 5%, 83 participants were recruited. Informed consent was obtained prior to measurements. The Institutional Review Board of CHA University approved the study (1044308-202303-HR-070-02). The study protocol was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eProtocol\u003c/p\u003e\u003cp\u003eParticipants were asked to indicate their age, height, weight, and sex. The three-guide SDT [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] was used to assess SD, and the LSST was used to measure the distance between the thoracic spine and scapula [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The SDT and LSST were performed by 25- and 15-year-experienced certified athletic trainers, respectively (SDT k\u0026thinsp;=\u0026thinsp;0.78; LSST k\u0026thinsp;=\u0026thinsp;0.76) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. All participants were blinded to each other (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSDT\u003c/p\u003e\u003cp\u003eParticipants were asked to grasp dumbbells according to their body weight (1.4 kg for those weighed\u0026thinsp;\u0026lt;\u0026thinsp;68.1 kg and 2.3 kg for those weighed\u0026thinsp;\u0026ge;\u0026thinsp;68.1 kg). The participants were then asked to flex their shoulders with their elbow straight to 180\u0026deg; with the thumbs-up position for 3 s and then extend the shoulder to return to the neutral position for 3 s. The test was repeated five times [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The clinician palpated the scapular movement bilaterally to determine the SD grade. No evidence of abnormality in scapular movement was rated as normal, mild abnormality as subtle, and apparent abnormal movement as obvious [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The reliability of the SDT with palpation has been reported to be moderate to substantial (k\u0026thinsp;=\u0026thinsp;0.49\u0026ndash;0.64) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLSST\u003c/p\u003e\u003cp\u003eThe participants were asked to stand up, and three different shoulder positions were used to measure the distance between the thoracic spine and inferior angle of the scapula. The first position was the neutral position; the second was with the hands on the hips with the palm facing inferiorly; and the third was with the shoulder at 90\u0026deg; abduction and internal rotation of the thumb to point inferiorly [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A caliper (CAS, Yangju, Korea) was used to measure the distance from the T7 spinous process to the inferior angle of the scapula at all three positions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. All measurements were taken twice, and the mean was calculated for data analysis. A difference of \u0026ge;\u0026thinsp;1.5 cm in any of the three positions considered positive for LSST [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]; however, we only used quantitative distance data for data analysis. The reliability of the LSST is high (intraclass correlation coefficient [ICC]\u0026thinsp;\u0026gt;\u0026thinsp;0.87\u0026ndash;0.92) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNeck disability index (NDI)\u003c/p\u003e\u003cp\u003eParticipants were asked to complete the NDI questionnaire. The NDI is widely used for neck pain and disability [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The Korean version of the NDI questionnaire was used, and its reliability was excellent (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.93) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The NDI is measured on a scale of 0 to 100, with a higher NDI score indicating greater neck disability due to neck pain [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVAS for neck pain\u003c/p\u003e\u003cp\u003eParticipants were asked to determine their eligibility for the study by recording the worst neck pain they had experienced over the past week on a 100-mm horizontal line. They were instructed to rate their pain from 0 (no pain) to 10 (worst pain imaginable) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Participants with a score of 0 were excluded from the study.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll the statistical analyses were performed using SPSS version 29.0 (IBM Corp., Armonk, NY, USA). The Shapiro\u0026ndash;Wilk test was used to test the normal distribution, which was confirmed (p\u0026thinsp;\u0026gt;\u0026thinsp;.05). The dependent variable was the SDT grade (normal, subtle, and obvious), and the distances of LSST positions 1, 2, and 3 were independent variables. One-way analysis of variance was used to compare the LSST distance, age, sex, body weight, neck VAS, and NDI among the SDT grades. The least significant difference post-hoc test was also used. The SDT results were ranked data, and the LSST results were scaled data. Therefore, the Kendall rank correlation was used to analyze the relationship between the SDT and LSST. Pearson\u0026rsquo;s correlation was used to analyze the results of the LSST, neck VAS, and NDI. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Dominant and non-dominant arms were analyzed separately.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 83 office workers (49 males and 34 females) with CNP participated in the study. In the dominant shoulders, age (p\u0026thinsp;=\u0026thinsp;.805), sex (p\u0026thinsp;=\u0026thinsp;.507), body weight (p\u0026thinsp;=\u0026thinsp;.576), and neck VAS score (p\u0026thinsp;=\u0026thinsp;.104) were not significantly different among the SDT grades. Height (p\u0026thinsp;=\u0026thinsp;.038) and NDI (p\u0026thinsp;=\u0026thinsp;.021) differed significantly between the groups. The SD group was significantly taller than the normal and subtle SD groups. The normal SD group showed a significantly lower NDI than the subtle and obvious SD groups (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;1. Characteristics of the participants who underwent dominant shoulder SDT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eD SDT Test (n\u0026thinsp;=\u0026thinsp;83)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSubtle\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eObvious\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eLSD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e\u003cp\u003e(29.62\u0026ndash;37.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e\u003cp\u003e(30.36\u0026ndash;34.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\u003cp\u003e(30.8\u0026ndash;34.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.805\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003cp\u003e(M\u0026thinsp;=\u0026thinsp;1, F\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003cp\u003e(1.17\u0026ndash;1.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0,18\u003c/p\u003e\u003cp\u003e(1.28\u0026ndash;1.63))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003cp\u003e(1.18\u0026ndash;1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.507\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight, cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e166.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e\u003cp\u003e(162.74\u0026ndash;171.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e\u003cp\u003e(165.13\u0026ndash;169.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e171.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e\u003cp\u003e(169.01\u0026ndash;173.47))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.038*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNormal\u0026thinsp;\u0026lt;\u0026thinsp;Obvious\u003c/p\u003e\u003cp\u003eSubtle\u0026thinsp;\u0026lt;\u0026thinsp;Obvious\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody weight, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.17\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92\u003c/p\u003e\u003cp\u003e(58.25\u0026ndash;78.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\u003cp\u003e(62.31\u0026ndash;68.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e\u003cp\u003e(63.8\u0026ndash;73.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeck VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003cp\u003e(1.72\u0026ndash;3.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;.068\u003c/p\u003e\u003cp\u003e(3.15\u0026ndash;4.52))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\u003cp\u003e(3.05\u0026ndash;4.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e\u003cp\u003e(3.53\u0026ndash;8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\u003cp\u003e(9.38\u0026ndash;14.32))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e\u003cp\u003e(8.32\u0026ndash;11.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.021*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNormal\u0026thinsp;\u0026lt;\u0026thinsp;Subtle\u003c/p\u003e\u003cp\u003eNormal\u0026thinsp;\u0026lt;\u0026thinsp;Obvious\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eD, dominant; NDI, neck disability index; VAS, visual analogue scale; SDT, scapular dyskinesis test; M, male; F, female; CI, confidence interval; LSD, least significant difference; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003eIn the non-dominant shoulder, there were no significant differences in age (p\u0026thinsp;=\u0026thinsp;.213), sex (p\u0026thinsp;=\u0026thinsp;.248), height (p\u0026thinsp;=\u0026thinsp;.433), body weight (p\u0026thinsp;=\u0026thinsp;.615), neck VAS score (p\u0026thinsp;=\u0026thinsp;.801), and NDI (p\u0026thinsp;=\u0026thinsp;.952) among the normal, subtle, and obvious SD groups (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;2. Characteristics of the participants who underwent non-dominant shoulder SDT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eND SDT Test\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSubtle\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eObvious\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eLSD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e\u003cp\u003e(30.05\u0026ndash;35.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\u003cp\u003e(31.61\u0026ndash;35.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\u003cp\u003e(29.52\u0026ndash;32.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.574\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003cp\u003e(M\u0026thinsp;=\u0026thinsp;1, F\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\u003cp\u003e(1.28\u0026ndash;1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003cp\u003e(1.14\u0026ndash;1.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003cp\u003e(1.27\u0026ndash;1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight, cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e168.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e\u003cp\u003e(164.92\u0026ndash;171.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e170.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\u003cp\u003e(167.68\u0026ndash;173.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e\u003cp\u003e(166.08\u0026ndash;170.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.846\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody weight, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.75\u003c/p\u003e\u003cp\u003e(61.14\u0026ndash;72.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.09\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e\u003cp\u003e(63.93\u0026ndash;74.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e\u003cp\u003e(61.43\u0026ndash;70.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeck VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003cp\u003e(2.6\u0026ndash;4.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003cp\u003e(2.99\u0026ndash;4.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003cp\u003e(2.87\u0026ndash;3.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e\u003cp\u003e(6.67\u0026ndash;13.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e\u003cp\u003e(8.07\u0026ndash;12.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e\u003cp\u003e(8.23\u0026ndash;12.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.952\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eND, non-dominant; NDI, neck disability index; VAS, visual analogue scale; SDT, scapular dyskinesis test; M, male; F, female; CI, confidence interval; LSD, least significant difference\u003c/p\u003e\u003cp\u003eIn the dominant shoulders, LSST position 2 showed a significant difference in length (p\u0026thinsp;=\u0026thinsp;.002). The obvious SD group exhibited a longer distance than the subtle SD group. There were no significant differences in the LSST positions 1 and 3 among the SDT groups (Table\u0026nbsp;3).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;3. LSST length with dominant shoulder SDT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eD SDT\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSDT Normal\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSDT Subtle\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSDT Obvious\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eLSD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLSST 1, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e\u003cp\u003e(82.41\u0026ndash;94.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81\u003c/p\u003e\u003cp\u003e(79.66\u0026ndash;87.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e\u003cp\u003e(85.75\u0026ndash;94.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLSST 2, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67\u003c/p\u003e\u003cp\u003e(88.1\u0026ndash;99.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\u003cp\u003e(86.85\u0026ndash;93.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\u003cp\u003e(95.33\u0026ndash;102.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSubtle\u0026thinsp;\u0026lt;\u0026thinsp;Obvious\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLSST 3, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92.98\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\u003cp\u003e(86.17\u0026ndash;99.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e\u003cp\u003e(87.25\u0026ndash;96.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39\u003c/p\u003e\u003cp\u003e(93.86\u0026ndash;102.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eD, dominant; CI, confidence interval; SDT, scapular dyskinesis test; LSST, lateral scapular slide test; LSD, least significance difference; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003eIn the non-dominant shoulder, LSST position 2 showed a significant difference in length (p\u0026thinsp;=\u0026thinsp;.019). The subtle and obvious SD groups exhibited longer distances than the normal SD group. There were no significant differences in LSST positions 1 and 3 among the SDT groups (Table\u0026nbsp;4).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;4. LSST length with non-dominant shoulder SDT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eND SD (n\u0026thinsp;=\u0026thinsp;83)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSDT Normal Mean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSDT Subtle\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSDT Obvious\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMean (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eLSD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLSST 1, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e\u003cp\u003e(77.59\u0026ndash;87.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\u003cp\u003e(82.4\u0026ndash;90.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\u003cp\u003e(81.93\u0026ndash;90.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.845\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLSST 2, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e\u003cp\u003e(82.95\u0026ndash;90.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\u003cp\u003e(89.72\u0026ndash;97.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e\u003cp\u003e(90.85\u0026ndash;96.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.019*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNormal\u0026thinsp;\u0026lt;\u0026thinsp;Subtle\u003c/p\u003e\u003cp\u003eNormal\u0026thinsp;\u0026lt;\u0026thinsp;Obvious\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLSST 3, mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e\u003cp\u003e(84.22\u0026ndash;95.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e\u003cp\u003e(87.11\u0026ndash;95.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e\u003cp\u003e(89.9\u0026ndash;100.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eND, non-dominant; SDT, scapular dyskinesis test; LSST, lateral scapular slide test; LSD, least significance difference; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003eSignificant positive correlations were found between the SDT and LSST position 2 (r\u0026thinsp;=\u0026thinsp;0.22, p\u0026thinsp;=\u0026thinsp;.04) in the dominant and non-dominant (r\u0026thinsp;=\u0026thinsp;0.21, p\u0026thinsp;=\u0026thinsp;.049) shoulders. No significant correlation was found between the SDT and LSST positions 1 and 3 in the dominant and non-dominant shoulders (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between the SDT and LSST\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScapular dyskinesis test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDT D / LSST 1 D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDT D / LSST 2 D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDT D / LSST 3 D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDT ND / LSST 1 ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDT ND / LSST 2 ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDT ND / LSST 3 ND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eD, dominant; ND, non-dominant; SDT, scapular dyskinesis test; LSST, lateral scapular slide test; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003eA significant negative correlation was identified between LSST position 3 and neck VAS scores in the non-dominant group (p\u0026thinsp;=\u0026thinsp;.04). However, there was no significant correlation between other LSST positions and VAS/NDI (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between the LSST and neck VAS score and NDI\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLateral scapular slide test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003cp\u003ecoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eDominant arm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST1-N.VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.3\u0026ndash;0.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST2-N.VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.22\u0026ndash;0.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST3-N.VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.32\u0026ndash;0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST1-NDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.22\u0026ndash;0.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.0189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST2-NDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.24\u0026ndash;0.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST3-NDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.25\u0026ndash;0.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eNon-dominant arm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST1-N.VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.33\u0026ndash;0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.1027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST2-N.VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.28\u0026ndash;0.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST3-N.VAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.41\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.9995\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.04 *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST1-NDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.23\u0026ndash;0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST2-NDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.34\u0026ndash;0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.1686\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLSST3-NDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c4\"\u003e\u003cp\u003e(-0.36\u0026ndash;0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.4132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLSST, lateral scapular slide test; N.VAS, neck visual analogue scale; NDI, neck disability index; CI, confidence interval; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe SD grades of office workers with CNP were assessed using the SDT and LSST. The SDT is a dynamic qualitative method, whereas the LSST is a static quantitative method [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The relationship between these two measures was analyzed to understand the SD grade and the distance between the thoracic spine and inferior angle of the scapula. This study aimed to explore the clinical advantages of combining SDT and LSST in office workers with CNP.\u003c/p\u003e\u003cp\u003eSubtle and obvious SD demonstrated significantly greater scapulothoracic distances in the LSST position. These findings are consistent with previous research [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Kibler (1998) reported that LSST positions 1 and 2 were performed with the shoulder relaxed, inducing minimal muscle activation, whereas position 3 was performed with activated scapular stabilizers with hands unsupported [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], increasing the likelihood of scapular control. The LSST assesses the bilateral distance between the thoracic spine and scapular inferior angle in three different shoulder positions, and a side-to-side difference\u0026thinsp;\u0026gt;\u0026thinsp;1.5 cm is used to identify SD [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This approach assumed that the opposite side of the shoulder was normal [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, a previous study found that 72.48% of computer programmers exhibit bilateral SD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, the SD rates were significantly higher with the SDT (89.9%) than with the LSST (23%) in the same population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The LSST is a static posture measurement; therefore, scapular motion cannot be evaluated [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. SD should be evaluated based on dynamic movement patterns [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], Although computed tomography has been proposed as a highly accurate tool for assessing scapular position [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], limitations in cost and accessibility may hinder its practical application, and similar to the LSST, it is also a static posture measurement [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Nevertheless, the LSST demonstrates high inter-rater reliability (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.87) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and serves as a simple yet reliable method for quantitative assessment using basic tools such as a tape measure or caliper [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, combining the SDT (qualitative method) and LSST (quantitative method) offers a practical and clinically feasible approach for SD evaluation [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] in CNP with SD.\u003c/p\u003e\u003cp\u003eA positive correlation was observed between the SDT grades and LSST position 2 distance in both the dominant (p\u0026thinsp;=\u0026thinsp;.040) and non-dominant (p\u0026thinsp;=\u0026thinsp;.049) shoulders. These findings suggest that severe SD grades in office workers with CNP are associated with increased scapulothoracic distance in LSST position 2. This may reflect a loss of control over scapular positioning under static and dynamic conditions, resulting in scapular protraction [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Yildiz et al. (2019) reported a significant reduction in middle trapezius activity in SD compared with that in normal scapular movement [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Scapular protraction with SD increases the distance between the scapula and thoracic spine [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This may be related to the weakness and lengthening of the middle trapezius and rhomboid muscles. SD involves an excessively protracted scapula at rest or during arm movement [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The protracted position is characterized by anterior displacement of the scapula over the thoracic wall [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], which is primarily facilitated by the serratus anterior and pectoralis major and minor [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The serratus punch is commonly used to enhance scapular stabilization because it maximally activates and shortens the serratus anterior [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Previous studies have reported that SD is frequently associated with weakness in the serratus anterior [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, the findings of our study are in contrast to those of previous studies. Serratus anterior activation-focused exercises may increase the scapulothoracic distance with SD. Scapular stabilization relies on coupled forces of the trapezius, serratus anterior, and rhomboid muscles [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The rhomboid muscle particularly contributes to the mediolateral control of scapular motion [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Chaudhary et al. (2024) suggested that an effective shoulder SD rehabilitation emphasized rhomboid-focused training [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Based on the present findings, office workers with CNP and more severe SD showed a greater distance between the scapula and thoracic spine. Further research is warranted to evaluate the effects of rhomboid-and middle trapezius-centered interventions to treat SD in office workers with CNP.\u003c/p\u003e\u003cp\u003eA significant difference was found in the NDI scores between individuals with and without SD, as identified by the SDT on the dominant arm (p\u0026thinsp;=\u0026thinsp;0.021). Office workers with CNP who exhibited subtle or obvious SD had significantly higher NDI scores than those with normal scapular motion. Jensen et al. (1999) suggested that the frequent use of a mouse with a dominant arm may reduce the resting time in the upper trapezius [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The altered resting scapular posture on the dominant side, characterized by greater internal rotation and anterior tilt than on the non-dominant side [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], may contribute to altered scapular kinematics. Moreover, no significant correlations were found between the LSST distances on the dominant side and the neck VAS or NDI scores. Similarly, no significant associations were observed between the SDT on the non-dominant side and neck VAS or NDI. The SDT was significantly associated with NDI, which may be related to the functional impairment linked to dynamic scapular control [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. By contrast, the LSST showed a significant association with the neck VAS score, which may be related to posture-related pain [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. These findings highlighted the value of using both assessments for a more comprehensive evaluation.\u003c/p\u003e\u003cp\u003eA significant correlation was observed between LSST Position 3 and the neck VAS score on the non-dominant side (p\u0026thinsp;=\u0026thinsp;0.049) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e6\u003c/span\u003e). This may indicate that greater neuromuscular demand on the non-dominant side due to relatively lower motor control leads to fatigue and contributes to neck pain [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Altered muscle activation patterns may lead to abnormal scapular kinematics, resulting in scapular protraction, which increases the distance between the thoracic spine and scapula [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In a previous LSST-based study involving 36 office workers, the mean NDI score was 4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. By contrast, the present study, which included 83 participants and utilized both the SDT and LSST, revealed higher average NDI scores (dominant normal, 6.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64; subtle, 11.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47; and obvious, 10.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78; non-dominant normal, 9.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22; subtle, 10.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38; and obvious, 10.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96). Interestingly, these findings suggest that the non-dominant side, which is traditionally considered less loaded, can nonetheless exhibit meaningful functional impairments and perceived disability. This highlights the importance of bilateral evaluation for comprehensively assessing SD and guiding tailored interventions for office workers. The SDT measures scapular dynamic stability, which requires the coordinated activation of the upper trapezius, serratus anterior, lower trapezius, and rhomboids [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. By contrast, the LSST measures static positional differences [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and may not fully reflect neuromuscular control or functional scapular movements [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. While the SD in athletes is often associated with repetitive activity [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], office workers may develop SD owing to prolonged sitting, repetitive postures, and poor ergonomic conditions [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In this population, CNP is frequently accompanied by tightness of the upper trapezius, pectoralis minor, and levator scapulae [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], all of which are directly attached to the scapula and can alter its movement, potentially leading to SD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, office workers not only maintain prolonged sitting postures but also experience concomitant muscular tension and imbalances involving the muscles attached to the scapula. The combined use of the SDT and LSST may serve as a more comprehensive and appropriate approach for evaluating SD in this population.\u003c/p\u003e\u003cp\u003eA significant association was observed between SDT severity on the dominant arm and height (p\u0026thinsp;=\u0026thinsp;0.38), which is consistent with previous studies suggesting that anthropometric factors may influence upper-extremity kinematic [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. By contrast, no significant association between SDT severity and height was found on the non-dominant side, which may reflect the generally lower functional demand and habitual use of that limb. No significant differences were found in age, sex, body weight, or neck VAS scores among the normal, subtle, and obvious SD groups. Although female office workers are known to experience neck pain more frequently than males [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], our findings did not reveal significant sex differences in the neck VAS scores among individuals with SD. In athletes, repetitive overhead motions and muscle fatigue increase the prevalence of SD [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. By contrast, computer-based office workers are more likely to adopt prolonged postures involving a forward head position and rounded shoulders, which can alter scapular kinematics and muscle activation, thereby contributing to the development of SD [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Unlike athletes, office workers do not typically perform overhead activities, suggesting that reliance on the SDT alone may be insufficient for identifying SD in this population. Therefore, combining the static quantitative assessment of LSST position 2 with dynamic qualitative SDT may provide a more comprehensive evaluation of SD by accounting for both resting posture and movement characteristics in office workers with CNP. Further research is needed to explore the underlying mechanisms of SD in computer-based office workers and develop effective interventions that address both static and dynamic contributors.\u003c/p\u003e\u003cp\u003eThis study has several limitations. Participants were limited to office workers with CNP. Therefore, the current findings may not apply to other populations such as athletes or individuals with shoulder pathologies. Additionally, the SDT has been used to classify SD, although there is currently no established gold standard for its diagnosis. The three-grade classification system (normal, subtle, and obvious) used in this study demonstrated good reliability (ICC\u0026thinsp;=\u0026thinsp;0.86) [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]; however, its interpretation still depends on the evaluator. Furthermore, individual anthropometric differences were not controlled through normalization by height, and personal factors such as occupational tasks, previous sports participation, and sex-specific differences were not accounted for. Finally, all participants were recruited from Seoul, South Korea, which may limit the external validity of the findings to other regions or populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBy combining static and dynamic assessments, the LSST and SDT can provide a more comprehensive understanding of SD in office workers with CNP. A significant association was observed between the SD grade and scapulothoracic distance, particularly in LSST position 2, suggesting that an increased SD grade is linked to scapular protraction in office workers with CNP. Additionally, individuals with SD reported higher levels of neck disability. These findings highlight the importance of evaluating both static postural alignment and dynamic scapular control in clinical assessments. However, as the participants in this study were limited to office workers with CNP, further research is required to examine populations with different occupational demands.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSD, scapular dyskinesis\u003c/p\u003e\n\u003cp\u003eCNP, chronic neck pain\u003c/p\u003e\n\u003cp\u003eLSST, lateral scapular slide test\u003c/p\u003e\n\u003cp\u003eVAS, visual analogue scale\u003c/p\u003e\n\u003cp\u003eNDI, neck disability index\u003c/p\u003e\n\u003cp\u003eICC, intraclass correlation coefficient\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: The Institutional Review Board of CHA University approved the study (1044308-202303-HR-070-02), and informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no funding available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYK led on study design, and SM conducted all literature searches, analyzed all data. YK reviewed the analysis of literature. SM drafted the initial manuscript, and YK reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the department of medicine, CHA University for the contributions to the development process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Department of Medicine, Graduate School, CHA University, Seongnam-si 13503, Republic of Korea\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: The 2013 consensus statement from the \u0026lsquo;Scapular Summit\u0026rsquo;. Br J Sports Med. 2013;47:877\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastelein B, Cools A, Parlevliet T, Cagnie B. Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated? A case-control study with surface and fine-wire EMG. J Electromyogr Kinesiol. 2016;31:136\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012;20:364\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalamh PA, Hanney WJ, Boles T, Holmes D, McMillan A, Wagner A, et al. Is it time to normalize scapular dyskinesis? The incidence of scapular dyskinesis in those with and without symptoms: A systematic review of the literature. Int J Sports Phys Ther. 2023;V18:558\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa R, Brimmo OA, Li X, Colbert L. Current concepts in rehabilitation for traumatic anterior shoulder instability. Curr Rev Musculoskelet Med. 2017;10:499\u0026ndash;506.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48:692\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYildiz TI, Cools A, Duzgun I. Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain. Clin Biomech (Bristol). 2019;70:97\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoon SE, Kim YK. Neck and shoulder pain with scapular dyskinesis in computer office workers. Med (Kaunas). 2023;59:2159.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D. Individual and work related risk factors for neck pain among office workers: A cross sectional study. Eur Spine J. 2007;16:679\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzeto GP, Straker LM, O\u0026rsquo;Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work\u0026mdash;1: Neck and shoulder muscle recruitment patterns. Man Ther. 2005;10:270\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzeto GP, Straker LM, O\u0026rsquo;Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work\u0026mdash;2: Neck and shoulder kinematics. Man Ther. 2005;10:281\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;zdemir F, Toy Ş, Kızılay F, Avcı ZT, Altay Z, \u0026Ccedil;olak C. Effects of scapular stabilization exercises in patients of chronic neck pain with scapular dyskinesis: A quasi-experimental study. Turk J Phys Med Rehabil. 2021;67:77\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaraağa\u0026ccedil; A, Arslan SA, Keskin ED. Assessment of pain, scapulothoracic muscle strength, endurance and scapular dyskinesis in individuals with and without nonspecific chronic neck pain: A cross-sectional study. J Bodyw Mov Ther. 2023;35:261\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcClure P, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis, part 1: Reliability. J Athl Train. 2009;44:160\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBen Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26:325\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25:1240\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO'Connor S, McCaffrey N, Whyte E, Moran K. The development and reliability of a simple field-based screening tool to assess for scapular dyskinesis. J Sport Rehabil. 2016;25:2015\u0026ndash;0054.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParaskevopoulos E, Papandreou M, Gliatis J. Reliability of assessment methods for scapular dyskinesis in asymptomatic subjects: A systematic review. Acta Orthop Traumatol Turc. 2020;54:546\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: A reliability study. J Shoulder Elb Surg. 2002;11:550\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurtis T, Roush JR. The lateral scapular slide test: A reliability study of males with and without shoulder pathology. N Am J Sports Phys Ther. 2006;1:140\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang T-S, Huang H-Y, Wang T-G, Tsai Y-S, Lin J-J. Comprehensive classification test of scapular dyskinesis: A reliability study. Man Ther. 2015;20:427\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOyama S, Myers JB, Wassinger CA, Daniel Ricci R, Lephart SM. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008;43:565\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLarsen CM, S\u0026oslash;gaard K, Eshoj H, Ingwersen K, Juul-Kristensen B. Clinical assessment methods for scapular position and function. An inter-rater reliability study. Physiother Theor Pract. 2020;36:1399\u0026ndash;420.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShadmehr A, Bagheri H, Ansari NN, Sarafraz H. The reliability measurements of lateral scapular slide test at three different degrees of shoulder joint abduction. Br J Sports Med. 2010;44:289\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFejer R. Categorising the severity of neck pain. In: Categorising Severity Neck Pain. 2006;2006.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVongsirinavarat M, Wangbunkhong S, Sakulsriprasert P, Petviset H. Prevalence of scapular dyskinesis in office workers with neck and scapular pain. Int J Occup Saf Ergon. 2023;29:50\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepreli O, Ender Angın E, Yatar I, Kirmizigil B, Malkoc M. Scapular dyskinesis and work-related pain in office workers-a pilot study. Int J Phys Ther Rehab. 2016;2:2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzunlu N, Tekeli H, Baltaci G. Lateral scapular slide test and scapular mobility in volleyball players. J Athl Train. 2011;46:438\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for measurement of functional outcome for cervical pain or dysfunction: A systematic review. Spine. 2002;27:515\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong K-J, Choi B-W, Choi B-R, Seo G-B. Cross-cultural adaptation and validation of the Korean version of the neck disability index. Spine. 2010;35:E1045\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHowell ER. The association between neck pain, the Neck Disability Index and cervical ranges of motion: A narrative review. J Can Chiropr Assoc. 2011;55:211\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTate AR, McClure P, Kareha S, Irwin D, Barbe MF. A clinical method for identifying scapular dyskinesis, part 2: Validity. J Athl Train. 2009;44:165\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKibler WB, Sciascia A. Current concepts: Scapular dyskinesis. Br J Sports Med. 2010;44:300\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark J-Y, Hwang J-T, Kim K-M, Makkar D, Moon SG, Han K-J. How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography-a new diagnostic modality. J Shoulder Elb Surg. 2013;22:1084\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark J-Y, Hwang J-T, Oh K-S, Kim S-J, Kim NR, Cha M-J. Revisit to scapular dyskinesis: Three-dimensional wing computed tomography in prone position. J Shoulder Elb Surg. 2014;23:821\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJayasinghe GS. Scapula dyskinesis: A review of current concepts and evaluation of assessment tools. Curr Sports Med Rep. 2018;17:338\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKibler WB, Sciascia A. Evaluation and management of scapular dyskinesis in overhead athletes. Curr Rev Musculoskelet Med. 2019;12:515\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBen Kibler WB, Lockhart JW, Cromwell R, Sciascia A. Managing scapular dyskinesis. Phys Med Rehabil Clin N Am. 2023;34:427\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaine R, Voight ML. The role of the scapula. Int J Sports Phys Ther. 2013;8:617\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaggi A, Alexander S. Suppl. 6, M13: Rehabilitation for shoulder instability\u0026ndash;current approaches. Open Orthop J. 2017;11:957\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastelein B, Cagnie B, Parlevliet T, Cools A. Serratus anterior or pectoralis minor: Which muscle has the upper hand during protraction exercises? Man Ther. 2016;22:158\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang T-S, Ou H-L, Huang C-Y, Lin J-J. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elb Surg. 2015;24:1227\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetersen SA. Posterior shoulder instability. Orthop Clin North Am. 2000;31:263\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaudhary A, Sharma A, Zaidi S, Rizvi M. Transforming Rehabilitation for Scapular Dyskinesia: The role of Modified Robbery Exercises in enhancing Muscle Function, reducing Disability, and improving Quality of Life. IJOPRP. 2024;3:161\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJensen C, Finsen L, Hansen K, Christensen H. Upper trapezius muscle activity patterns during repetitive manual material handling and work with a computer mouse. J Electromyogr Kinesiol. 1999;9:317\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim S-R, Kang M-H, Bahng S-Y, An J-K, Lee J-Y, Park S-Y, et al. Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain. J Phys Ther Sci. 2016;28:1508\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoirier G, Papaxanthis C, Mourey F, Lebigre M, Gaveau J. Muscle effort is best minimized by the right-dominant arm in the gravity field. J Neurophysiol. 2022;127:1117\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJeong JH, Kim YK. Association of scapular dyskinesis with neck and shoulder function and training period in Brazilian Ju-Jitsu athletes. Med (Kaunas). 2023;59:1481.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJung J. Scapular dyskinesis in elite boxers with neck disa; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSree SD. To evaluate scapulohumeral rhythm in scapular dyskinesia in software professionals with neck pain. Indian J Physiother Occup Ther 2020;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTorabi TP, Juul-Kristensen B, Dam M, Zebis MK, van den Tillaar R, Bencke J. Comparison of shoulder kinematics and muscle activation of female elite handball players with and without pain\u0026mdash;An explorative cross-sectional study. Front Sports Act Living. 2022;4:868263.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKorhonen T, Ketola R, Toivonen R, Luukkonen R, H\u0026auml;kk\u0026auml;nen M, Viikari-Juntura E. Work related and individual predictors for incident neck pain among office employees working with video display units. Occup Environ Med. 2003;60:475\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEbaugh DD, McClure PW, Karduna AR. Effects of shoulder muscle fatigue caused by repetitive overhead activities on scapulothoracic and glenohumeral kinematics. J Electromyogr Kinesiol. 2006;16:224\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAndres J, Painter PJ, McIlvain G, Timmons MK. The effect of repeated shoulder motion on scapular dyskinesis in army ROTC cadets. Mil Med. 2020;185:e811\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20:701\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRossi DM, Pedroni CR, Martins J, de Oliveira AS. Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLoS ONE. 2017;12:e0181518.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"scapular dyskinesis, chronic neck pain, computer-based office workers, scapular dyskinesis test, lateral scapular slide test","lastPublishedDoi":"10.21203/rs.3.rs-7203202/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7203202/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eScapular dyskinesis is associated with shoulder dysfunction and chronic neck pain, particularly in computer-based office workers. Although scapular dyskinesis and lateral scapular slide tests are commonly used in clinical settings, each has limitations when used independently. In addition, only a few studies have examined the clinical relationship between these two testing methods, particularly in individuals with chronic neck pain in whom scapular dysfunction is highly prevalent. This study aimed to examine the relationship between the scapular dyskinesis and lateral scapular slide tests and explore their combined utility in assessing scapular dysfunction in individuals with chronic neck pain.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eEighty-three office workers (49 males and 34 females) with chronic neck pain were recruited from three information technology companies in Seoul, Korea. The severity of scapular dyskinesis was assessed using a three-grade scapular dyskinesis test (normal, subtle, and obvious), and the scapulothoracic distance was measured at three arm positions using the lateral scapular slide test. Neck disability index and visual analogue scale scores were also assessed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSignificant differences were found in the lateral scapular slide test position 2 distance between the scapular dyskinesis test grades in both the dominant (p\u0026thinsp;=\u0026thinsp;0.0021) and non-dominant arms (p\u0026thinsp;=\u0026thinsp;0.0195). Individuals with subtle or obvious scapular dyskinesis exhibited significantly greater scapulothoracic distances than those with normal scapular motion. A positive correlation was observed between scapular dyskinesis test severity and lateral scapular slide test position 2 in both arms (dominant, p\u0026thinsp;=\u0026thinsp;0.040; non-dominant, p\u0026thinsp;=\u0026thinsp;0.0492). Participants with scapular dyskinesis also had higher neck disability index scores on the dominant side (p\u0026thinsp;=\u0026thinsp;0.0214), but no significant associations were found with visual analogue scale.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCombining dynamic scapular dyskinesis and static lateral scapular slide tests provides a more comprehensive evaluation of scapular dysfunction in office workers with chronic neck pain. These findings underscore the need to assess postural alignment and dynamic scapular control in clinical settings. Further research is needed to validate these findings in diverse occupational populations.\u003c/p\u003e","manuscriptTitle":"Scapular dyskinesis and lateral scapular slide tests to assess scapular dyskinesis with chronic neck pain in office workers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 16:37:43","doi":"10.21203/rs.3.rs-7203202/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-14T07:44:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T17:26:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-11T12:41:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-26T11:04:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T17:08:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280191812224348167211548190528909357477","date":"2025-09-21T08:51:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334266717253024255380484022398039782046","date":"2025-09-21T07:53:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132936717773011388434078845176894069846","date":"2025-09-19T07:39:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112127371070370867723679988103515987513","date":"2025-09-19T06:46:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-19T06:41:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T15:28:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-06T07:33:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-06T07:32:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-07-24T08:08:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67dbd123-007b-4a12-be7a-c86de5763137","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:00:49+00:00","versionOfRecord":{"articleIdentity":"rs-7203202","link":"https://doi.org/10.1186/s12891-026-09718-9","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2026-03-10 15:57:45","publishedOnDateReadable":"March 10th, 2026"},"versionCreatedAt":"2025-09-30 16:37:43","video":"","vorDoi":"10.1186/s12891-026-09718-9","vorDoiUrl":"https://doi.org/10.1186/s12891-026-09718-9","workflowStages":[]},"version":"v1","identity":"rs-7203202","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7203202","identity":"rs-7203202","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}