Muscle activity and scapular kinematics in individuals with multidirectional shoulder instability: A systematic review

Ann Phys Rehabil Med. 2021 Jan;64(1):101457. doi: 10.1016/ Epub 2020 Nov 28.


Background: Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.

Objective: This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.

Method: The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration.

Results: After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface.

Conclusion: There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.

Keywords: Electromyography; Kinematics; Muscle activity; Scapula; Shoulder instability.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Biomechanical Phenomena
  • Humans
  • Joint Instability* / physiopathology
  • Muscle, Skeletal / physiology*
  • Range of Motion, Articular
  • Scapula
  • Shoulder / physiopathology
  • Shoulder Joint* / physiopathology