Immediate Effects of Scapular Mobilization on Shoulder Range of Motion and Pain Level in Patients with Proximal Humerus Fractures

Year 2026, Volume: 4 Issue: 1, 1 - 5, 23.01.2026

Ezgi Ünüvar Yüksel , Nazli Busra Cıgercıoglu

Abstract

Purpose: Pain and muscle spasms around the scapula are common following proximal humerus fractures and can adversely effect shoulder function. This study aimed to examine the immediate effects of scapular mobilization on shoulder range of motion and pain level in patients with proximal humerus fractures.
Method: Twenty-eight patients (mean age: 54.20±4.36 years) with conservatively treated proximal humerus fractures were included in the study. Pain level was assessed using the Visual Analog Scale, while shoulder flexion and abduction angles were measured with a goniometer. Scapular mobilization was performed for approximately 10 minutes, consisting of 10 repetitions in medio-lateral, supero-inferior, and circumduction movements. Evaluations were conducted on the day the arm sling was removed, both before and after the scapular mobilization intervention.
Results: Immediately after scapular mobilization, significant improvements were observed in shoulder flexion (p<0.001) and abduction (p<0.001), with increases of 14.46° and 15.52°, respectively. Resting pain levels also significantly decreased (p<0.001), with a reduction of 2.41 cm.
Discussion: Scapular mobilization significantly improves shoulder range of motion and reduces pain in patients with proximal humerus fractures, suggesting its potential as an effective physiotherapy approach in the acute rehabilitation phase.

Keywords

bone fracture , joint mobilization , pain , range of motion , scapula

Ethical Statement

Ethical approval was obtained from the Hacettepe University Faculty of Physical Therapy and Rehabilitation Unit Research Ethics Committee (FTREK24/122).

Supporting Institution

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Thanks

The authors would like to express their deepest thanks to Prof. Dr. Hande Guney-Deniz for her invaluable contributions and continuous support throughout this study.

References

• 1. Konrad GG, Mehlhorn A, Kühle J, Strohm PC, Südkamp NP. Proximal humerus fractures - current treatment options. Acta Chir Orthop Traumatol Cech. 2008;75(6):413-21.
• 2. Bhambra T, Souroullas P, Wright AP, Gandhi M. Evidence-based management of proximal humerus fractures. Orthopaedics and Trauma. 2023;37(5):296-302.
• 3. Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma. 2011;25(10):612-7.
• 4. Lefevre-Colau MM, Babinet A, Fayad F, Fermanian J, Anract P, Roren A, et al. Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial. J Bone Joint Surg Am. 2007;89(12):2582-90.
• 5. Suphakitchanusan W, Kerdsomnuek P, Jamkrajang P, Fossum BW, Sudjai N, Paugchawee J, et al. Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes. J Shoulder Elbow Surg. 2023;32(10):e504-e15.
• 6. Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D, Imhoff AB, et al. Shoulder Stiffness: Current Concepts and Concerns. Arthroscopy. 2016;32(7):1402-14.
• 7. Ranieri R, Lacouture-Suarez JD, Ferrero M, Longobardi V, Cacace F, Ferrero A, et al. Early rehabilitation vs. conventional immobilization in nonoperative treatment of proximal humeral fracture: a systematic review. Eur Rev Med Pharmacol Sci. 2024;28(11):3771-80.
• 8. Duzgun I, Turgut E, Eraslan L, Elbasan B, Oskay D, Atay OA. Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization? J Musculoskelet Neuronal Interact. 2019;19(3):311-6.
• 9. Surenkok O, Aytar A, Baltaci G. Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial. J Sport Rehabil. 2009;18(4):493-501.
• 10. Yang JL, Jan MH, Chang CW, Lin JJ. Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial. Man Ther. 2012;17(1):47-52.
• 11. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52.
• 12. Martínez R, Santana F, Pardo A, Torrens C. One Versus 3-Week Immobilization Period for Nonoperatively Treated Proximal Humeral Fractures: A Prospective Randomized Trial. J Bone Joint Surg Am. 2021;103(16):1491-8.
• 13. Handoll HH, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015(11):Cd000434.
• 14. Sinha U, Sarkar B, Kumar P. Effectiveness of Scapular Mobilization versus Myofascial Release of Subscapularis on Pain, ROM and Function in Subjects with Chronic Frozen Shoulder: A Comparative Study. Int J Health Sci Res. 2019;9:149-56.
• 15. Boruah L, Dutta A, Deka P, Roy J. To Study the Effect of Scapular Mobilization Versus Mobilization with Movement to Reduce Pain and Improve Gleno-Humeral Range of Motion in Adhesive Capsulitis of Shoulder: A Comparative Study. Int J Physiother.. 2015;2:811-8.
• 16. Fani M, Ebrahimi S, Ghanbari A. Evaluation of scapular mobilization and comparison to pectoralis minor stretching in individuals with rounded shoulder posture: A randomized controlled trial. J Bodyw Mov Ther. 2020;24(4):367-72.
• 17. Gutiérrez-Espinoza H, Pinto-Concha S, Sepúlveda-Osses O, Araya-Quintanilla F. Effectiveness of scapular mobilization in people with subacromial impingement syndrome: A randomized controlled trial. Ann Phys Rehabil Med. 2023;66(5):101744.
• 18. Aytar A, Baltaci G, Uhl TL, Tuzun H, Oztop P, Karatas M. The effects of scapular mobilization in patients with subacromial impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial. J Sport Rehabil. 2015;24(2):116-29.
• 19. Chimenti RL, Frey-Law LA, Sluka KA. A Mechanism-Based Approach to Physical Therapist Management of Pain. Phys Ther. 2018;98(5):302-14.
• 20. Fritschy JM, Sarter M. Repeated massage-like stimulation induces long-term effects on nociception: contribution of oxytocinergic mechanisms. Eur J Neurosci. 2009;29(4):868.
• 21. Agren G, Lundeberg T, Uvnäs-Moberg K, Sato A. The oxytocin antagonist 1-deamino-2-D-Tyr-(Oet)-4-Thr-8-Orn-oxytocin reverses the increase in the withdrawal response latency to thermal, but not mechanical nociceptive stimuli following oxytocin administration or massage-like stroking in rats. Neurosci Lett. 1995;187(1):49-52.