Effectiveness of Scapular Clock Exercises in Scapular Dyskinesia in Post-Operative Open Heart Surgery Patients

Effectiveness of Scapular Clock Exercises in Scapular Dyskinesia; A Randomized Clinical Trial


Lead Sponsor: University of Faisalabad

Source University of Faisalabad
Brief Summary

In patients after open-heart surgery, the complaint of scapular dyskinesia is very common. It occurs due to the weakness of the muscles surrounding the scapula. In this research, investigators checked the effectiveness of scapular clock exercises in scapular dyskinesia, in post-op open heart surgery patients. There were two groups, an intervention "Active group" and a 'control group'. The patients will be randomly assigned to each group equally. The treatment session was given for a period of 4 weeks, with 3 sessions each week. They were assessed before treatment, after 2 weeks and post-intervention.

Detailed Description

Scapular dyskinesia is the malalignment of the scapula. It occurs when the pectoralis muscle (pectoralis minor) becomes tight and there is the weakness of the trapezius muscle (lower fibers). It can commonly occur after open-heart surgery due to incision and prolonged bed rest. In this research, the effectiveness of scapular clock exercises was checked. These exercises can strengthen the weak trapezius muscle and also stretch the tight pectoralis minor muscle. By adding these exercises in cardiac rehabilitation the occurrence of scapular dyskinesia can be reduced. Post-op open heart surgery patients mostly present with complain of shoulder pain. Most of their treatment is directed towards shoulder joint while the scapula is usually ignored. So it is important to add exercises directed towards the scapula along with shoulder. In this study, The investigators will recruit 30 post-op cardiac surgery patients with complain of shoulder pain, with positive scapular dyskinesia. The sample size was calculated using formula and the values were taken from previous researches. Scapular assistance test and Scapular retraction test was used to find out patients with scapular dyskinesia. The subjects will then be randomly divided into two groups using online randomization generator. The interventional group was receive stretching and strengthening exercises with additional scapular clock exercises and the active control group will receive stretching and strengthening exercises. There was 3 sessions per week, for a period of 4 weeks. The patients was assessed prior to the treatment , then after 2 weeks and later after completion of 4 weeks. The tools for assessment include NPRS for pain, Quick-DASH for activity limitation of shoulder and goniometer for measuring range of motion of shoulder.

Overall Status Recruiting
Start Date 2022-04-15
Completion Date 2022-06-30
Primary Completion Date 2022-06-20
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Shoulder pain 4 weeks
Secondary Outcome
Measure Time Frame
Level of Shoulder activity limitation 4 weeks
Enrollment 30

Intervention Type: Other

Intervention Name: Scapular clock exercises

Description: In scapular clock exercises, the hand is placed on the wall in front of your body. Move the hand in direction of 12 and 6 o'clock to elevate and depress the scapula. Then move hands towards 9 o' clock and 3 o'clock direction to protract and retract the scapula. Hold each position for 10 seconds. From 3rd week and onward the patient will use thera-band and then perform clock exercises.

Arm Group Label: Group A

Other Name: Stretching and strengthening exercises (Physical Therapy)

Intervention Type: Other

Intervention Name: Stretching and strengthening exercises

Description: Stretching and strengthening exercises of shoulder and scapular muscles was performed including wall washes, corner stretch, pectoral muscles stretch and wall push ups.



Inclusion Criteria: - Patients whose open heart surgery is done at least 6weeks ago. - Subjects having shoulder and scapular region pain. - 50% or less loss of Active ROM of shoulder in abduction, flexion and external rotation. - Positive Scapular assistance (SAT) and Scapular retraction test. - Positive findings on observational examination of scapula, showing abnormal prominence of either inferior, medial or superior border of scapula. - Type I and Type II scapular dyskinesia present - Consented to take part in the study. Exclusion Criteria: - • Bilateral shoulder involvement - History of previous surgery on shoulder - Shoulder fracture - Glenohumeral or acromioclavicular joint Arthritis. - Neuromuscular disorders



Minimum Age:

35 Years

Maximum Age:

65 Years

Healthy Volunteers:


Overall Official
Last Name Role Affiliation
Izza Ayub, MS Physical Therapy Principal Investigator The University of Faisalabad
Overall Contact

Last Name: Aqsa Shahid, Doctor of Physical Therapy

Phone: 0301-8057342

Email: [email protected]

Facility: Status: Contact: Contact Backup: Faisalabad Institute of Cardiology Sana Zahir, Doctor of Physical Therapy 0306-6396683 [email protected]
Location Countries


Verification Date


Responsible Party

Type: Principal Investigator

Investigator Affiliation: University of Faisalabad

Investigator Full Name: Sana Zahir

Investigator Title: Dr Sana Zahir;PT and Dr Aqsa Shahid;PT

Has Expanded Access No
Condition Browse
Number Of Arms 2
Arm Group

Label: Group A

Type: Experimental

Description: The interventional group received stretching and strengthening exercises along with scapular clock exercises. For the first two weeks, only scapular clock exercises were performed by the patient actively. After 2 weeks, the subjects performed scapular clock exercises by using the thera-band.

Label: Group B

Type: Active Comparator

Description: The active control group received stretching and strengthening exercises only. The stretching and strengthening exercises include corner stretch, wall-washes and pectoralis minor muscle stretch.

Patient Data No
Study Design Info

Allocation: Randomized

Intervention Model: Parallel Assignment

Intervention Model Description: There were 30 subjects divided equally and randomly into Group A and Group B. Group A was receive the intervention while group B will be active control group. The duration of treatment will be equal for both groups, that is 3 sessions per week for a period of 4 weeks.

Primary Purpose: Treatment

Masking: Single (Participant)

Masking Description: Only the participants were masked. They did not know either they are in the interventional group or in the control group.

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