Clinical Biomechanics 29 (2014) 885–891

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Clinical Biomechanics
journal homepage: www.elsevier.com/locate/clinbiomech

The variable roles of the upper and lower subscapularis during

shoulder motion
James Wickham c, Tania Pizzari a,b,⁎, Simon Balster d, Charlotte Ganderton b, Lyn Watson b,d
a
Lower Extremity & Gait Studies Research Group, Australia
b
Department of Physiotherapy, La Trobe University, Victoria, Australia
c
School of Biomedical Science, Charles Sturt University, NSW, Australia
d
LifeCare Prahran Sports Medicine, Victoria, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: The varied roles of the subscapularis muscle as an internal rotator of the humerus, a shoulder abduc-
Received 13 March 2014 tor, a humeral head depressor and an anterior stabiliser may be a result of differing innervation and lines of
Accepted 29 July 2014 torque between its superior and inferior components. The aims of the study were to investigate the differences
in the level of muscle activation between the upper and lower subscapularis during abduction, flexion, internal
Keywords:
and external rotation movements, and temporal characteristics during abduction and flexion.
Electromyography
Methods: Intramuscular electrodes recorded electromyographic muscle activity from the upper and lower
Shoulder
Subscapularis
subscapularis muscles of the dominant throwing arm of twenty-four normal subjects. Participants completed
Rotator cuff ten repetitions of four shoulder movements — abduction, flexion, internal rotation and external rotation. Muscle
Activation activity was expressed as a percentage of maximum voluntary isometric contraction.
Findings: The lower subscapularis was found to activate at a higher level than the subscapularis during abduction,
flexion and external rotation movements and this was significant during concentric and eccentric phases of
abduction and flexion (b0.001). During internal rotation, upper subscapularis muscle activity mirrored that of
lower subscapularis, with a mean difference of 1.14%. Neither upper nor lower subscapularis had onset data com-
mencing prior to the abduction movement; however upper subscapularis activated significantly later than lower
subscapularis (P = 0.018).
Interpretation: The lower subscapularis has significantly higher muscle activity during shoulder elevation and this
might reflect its greater role as a humeral head depressor and anterior stabiliser.
© 2014 Elsevier Ltd. All rights reserved.

1. Introduction
The subscapularis muscle is crucial for normal shoulder movement
as it, along with supraspinatus, infraspinatus and teres minor, provides
a source of dynamic stability to the glenohumeral joint. Subscapularis is
described as an internal rotator of the humerus (Morag et al., 2011), a
shoulder abductor (Liu et al., 1997), a humeral head depressor (Inman
et al., 1944) and an anterior stabiliser (Ovesen and Nielsen, 1985) that
counterbalances infraspinatus in the axial plane and provides a power-
ful dynamic buttress on the anterior aspect of the joint (DePalma et al.,
1967).
The subscapularis muscle is considered to comprise upper and lower
segments that are innervated by two or more separate terminal
⁎ Corresponding author at: Department of Physiotherapy, La Trobe University,
Bundoora, Victoria 3086, Australia.
E-mail address: t.pizzari@latrobe.edu.au (T. Pizzari).
branches (Yung et al., 1996). However, the innervation pattern and or-
igins of the upper and lower subscapular nerves are distinctly variable
between individuals (Kerr, 1918, Lee et al., 2000, Yung et al., 1996).
These variations may indicate differential muscle activity between the
upper and lower subscapularis muscles (Kerr, 1918, McCann et al.,
1994). In addition, the broad origins, (Liu et al., 1997) and thus the
differing line of torque of each subscapularis muscle component, may
contribute to the inferior and superior portions of this muscle having
different actions — accounting for the large number of roles described
in previous studies (Inman et al., 1944, Liu et al., 1997, Morag et al.,
2011, Ovesen and Nielsen, 1985). As such, for a comprehensive under-
standing of the role of the rotator cuff, the differences in the upper
and lower subscapularis muscle activities during common shoulder
movements are important.
Numerous electromyographic studies have evaluated subscapularis
muscle activity in a normal population during common shoulder move-
ments (O'Connell et al., 2006, Pearl et al., 1992), rotator cuff rehabilita-
tion exercises (Ganderton and Pizzari, 2013) and sporting activities

http://dx.doi.org/10.1016/j.clinbiomech.2014.07.003
0268-0033/© 2014 Elsevier Ltd. All rights reserved.
886 J. Wickham et al. / Clinical Biomechanics 29 (2014) 885–891
(DiGiovine et al., 1992, Kadaba et al., 1992, Malanga et al., 1996).
Traditionally, studies have evaluated the subscapularis muscle as a sin-
gle muscle unit (Ganderton and Pizzari, 2013, Malanga et al., 1996).
Decker et al. (2003) differentiated superior and inferior components
in their methodology and found greater activity in the upper
subscapularis muscle compared to the lower subscapularis during the
forward punch, internal rotation at mid and high levels of abduction
and push up plus exercises. Nemeth et al. (1990) found no differences
in electromyographic (EMG) pattern or amplitude, however this was
determined subjectively via visual inspection using raw EMG signal
with no statistical comparison. Two further EMG studies found that
upper and lower portions of subscapularis exhibit differential activity de-
pending on shoulder position. During an internal rotation movement,
upper subscapularis muscle activity remains constant or decreases, and
lower subscapularis increases, with increased range of abduction (from
0 to 90°) (Kadaba et al., 1992, McCann et al., 1994). However both studies
did not statistically analyse the differences between the upper and lower
subscapularis. None of the papers measured the subscapularis activity
during external rotation. Thus, the primary aim of this study was to inves-
tigate the differences in the upper and lower subscapularis muscle activ-
ities during shoulder abduction, flexion, internal rotation and external
rotation movements and during seven maximum voluntary isometric
contractions (MVICs). The secondary aim was to evaluate the differences
in temporal characteristics (onset and termination) between the upper
and lower subscapularis during abduction and flexion.
2. Method
2.1. Participants
Twenty-four normal subjects (13 male, 11 female) aged between 18
and 37 years (X = 23.6 ± 5.3) volunteered to participate in this re-
search study. Normal participants had no past history of shoulder
pain, injury or surgery, or any allergy to adhesives, and were a sample
of convenience from a University population. The La Trobe University
Ethics Committee approved all research procedures reported in this
study and all participants gave written consent prior to participation.
2.2. Material and apparatus
Two bipolar fine wire intramuscular electrodes were prepared using
methods first described by Basmajian and Stecko (1962). Following
sterilisation, electrodes were inserted under real time ultrasound (HDI
3000, Universal Diagnostic Solutions, California) guidance into the
upper and lower subscapularis of the dominant throwing arm of the
participant using a 23-gauge hypodermic needle. The electrode position
was modified from that described by Nemeth et al. (1990), to allow two
electrodes to be inserted into the muscle. With the subject lying halfway
between supine and side-lying and with the arm abducted and the hand
placed behind the head, the lateral border of the scapula was palpated
with markings for needle insertion placed 20 mm anterior to the lateral
border at distances of 45–60 mm and 95–110 mm above the inferior
angle of the scapula (Fig. 1). Needle insertions varied within these two
length ranges due to differences in scapula length and the lack of a
reliable superior landmark in the axilla for standardisation (Wickham
et al., 2010).
An accelerometer angle processor was placed on the participants'
wrist to measure the start and finish of motion and the shoulder angle
during dynamic movements. A Delsys Bagnoli-16 EMG system and its
associated software analysis package (Delsys Inc., Boston, USA) were
used to accurately collect and analyse raw EMG data.
2.3. Procedure
Participants were permitted to practice the four shoulder move-
ments prior to testing. Ten repetitions of each shoulder movement
Fig. 1. Ultrasound probe placement for upper and lower subscapularis intramuscular
electrode insertions.
(abduction, flexion, internal and external rotation) were then
performed. Participants were given a 30 second rest between each rep-
etition to reduce fatigue effects and the order of these exercises was
randomised between participants to prevent order effects. During ab-
duction and flexion movements, participants held a light dumbbell in
the hand — the weight calculated as 25% of the force output (Lafayette
Manual Muscle Tester positioned on the subjects' wrist) for a maximum
voluntary isometric contraction (MVIC) performed at 90° abduction
(Wickham et al., 2010).
Participants stood in an anatomical position and performed an ab-
duction/adduction movement in the coronal plane (for abduction trials)
and a flexion movement in the sagittal plane (for flexion trials) within a
10 second recording period. The duration of each repetition was
standardised by having the investigator count the timing of the move-
ment aloud guided by the timing on the Delsys EMG system. To ensure
a standardised movement plane, each participant was required to pass
the hand between two chains hanging from the ceiling 20 cm apart
(Fig 2).
During rotation trials, participants completed isokinetic external and
internal rotation movements in sitting, with their arm held in 90° of
shoulder abduction in the coronal plane and 90° elbow flexion. For ex-
ternal rotation trials, participants moved against the KinCom isokinetic
dynamometer at a velocity of 90° per second from neutral rotation to
full external rotation, and from a fully externally rotated position to a
neutral rotation position for internal rotation trials. This method has
been shown to be safe and reliable to measure glenohumeral internal
and external rotation strength (Plotnikoff and MacIntyre, 2002).
In addition to the four shoulder movements, based on earlier data
(Wickham et al., 2010), 7 isometric MVICs were performed to allow
the EMG data to be normalized and to allow a comparison between
upper and lower subscapularis activity. These included: abduction at
90° of shoulder joint elevation in the coronal plane; flexion at 90° of
shoulder joint elevation in the sagittal plane; internal rotation at 90°
of shoulder joint elevation with neutral rotation; external rotation at
90° of shoulder joint elevation with neutral rotation; horizontal flexion
at 90° of shoulder joint elevation in coronal plane; retraction done
seated with arms at sides with subject told to squeeze shoulder blades
together as hard as possible and extension at 0° of shoulder joint eleva-
tion in the sagittal plane. The decision to include 7 MVIC positions was
made on the recommendation that multiple tests be performed in
order to obtain the optimum maximum value for a muscle's MVIC for
subsequent amplitude normalisation (Vera-Garcia et al., 2010). Each
MVIC was held for 5 s and a total of three MVICs were performed for
each movement with a three-minute rest between tests to prevent
fatigue limiting maximal output.
 J. Wickham et al. / Clinical Biomechanics 29 (2014) 885–891
Fig. 2. Dynamic flexion trial. a) Participant ready to commence trial. b) Participants' hand passing through the two chains hanging from the ceiling at 180° flexion.
2.4. Data analysis
The data analysis procedures used have been previously described
(Semciw et al., 2012). In brief, EMG data from the upper and lower
subscapularis muscles during abduction, flexion, internal and external
rotation movements and the seven maximum voluntary isometric
contractions were full wave rectified and low pass filtered at a cut-off
frequency of 6 Hz through a 4th order Butterworth filter with phase
lag. To obtain graphs for the isotonic movements, data was time normal-
ised to 100 points (Chapman et al., 2006, Franettovich et al., 2010).
Repetitions 4, 5, 6 and 7 were used to calculate RMS values in order to
reduce learning and fatigue effects (Malanga et al., 1996, Myers et al.,
2005, Yasojima et al., 2008).
To obtain the highest MVIC reference value, all MVIC positions were
analysed for each muscle. The MVIC value was derived from the highest
average intensity (root mean square: RMS) from a 600 ms window
taken from the middle of the recorded MVIC traces. The highest ampli-
tude value across the seven maximum voluntary isometric contractions
was considered the MVIC for each segment for each participant and
used to formulate the box-plots in Fig. 4. The RMS values obtained
from muscle onset to termination during the movement trials were
expressed as a percentage of the MVIC (%MVIC) value for each muscle.
Muscle onset and termination data were calculated for the abduc-
tion and flexion motions using the methods described by Wickham
et al. (2010), where muscle onset was visually determined as the first
detectable rise from the fluctuating baseline and to avoid bias the re-
searcher was blinded to the goniometer trace (Wickham and Brown,
2012). This visual method of onset determination has been shown to
be highly repeatable and correlated with computer derived methods
(Hodges and Bui, 1996). This exact onset method has been used previ-
ously by the authors of the current study and has been shown to be
887
highly reliable (intraclass correlation coefficient, ICC = 0.98)
(Wickham et al., 2010). Muscle onset was calculated as muscle onset
minus the movement onset to determine a value in seconds of when
(before or after) the beginning of the movement onset. Similarly, the
termination was determined by taking the value (degrees) when the
amplitude first dropped below the same amplitude threshold level on
the Y axis at which the onset was found (Wickham et al., 2010). Tempo-
ral data for the rotation motions could not be obtained due to the use of
the isokinetic dynamometer.
Where data were normally distributed, a paired t-test was
performed to compare %MVIC, onset and termination between the
upper and lower subscapularis and where data violated assumptions
of normality, a Wilcoxon signed-rank test was performed using IBM
SPSS (Version 19). To prevent committing a type II error in this explor-
atory study, a Bonferroni adjustment was not performed and an alpha of
N0.05 was used (Perneger, 1998). To provide an estimate of the magni-
tude of difference (effect size, ES) between the upper and lower
subscapularis, a standardised mean difference (SMD = mean differ-
ence/pooled SD) was calculated for all t-test comparisons. Where
Wilcoxon signed-rank tests were performed, a standardised effect size
was calculated by dividing the z-score of the Wilcoxon signed-rank
test by the square root of the total sample size (Field, 2013).
3. Results
Mean (standard deviation: SD) muscle intensity, or median (inter-
quartile range: IQR) muscle intensity and overall average contraction
intensity (RMS) values for the upper and lower subscapularis muscles
were compared during four shoulder movements in a normal popula-
tion (Table 1). Fig. 3a and b illustrates grand ensembles of the upper
and lower subscapularis muscle activities during abduction and flexion
888 J. Wickham et al. / Clinical Biomechanics 29 (2014) 885–891

Table 1
%MVIC mean (standard deviation), median (inter-quartile range) and P-value for upper and lower subscapularis muscles during abduction, flexion, and internal and external rotation.

Movement Phase Muscle Mean (SD) Median (IQR) P-value Effect size

Abduction Concentric Upper subscapularis 6.99(3.79) 6.65(6.85) b0.001a 1.43

Lower subscapularis 13.60(6.26) 15.53(11.97)
Eccentric Upper subscapularis 5.05(1.79) 5.53(2.71) b0.001a 1.41
Lower subscapularis 9.95(4.24) 11.39(5.46)
Total Upper subscapularis 8.68(8.09) 5.67(10.66) 0.018a 0.56
Lower subscapularis 16.25(14.57) 12.53(14.78)
a
Flexion Concentric Upper subscapularis 1.72(0.55) 1.99(0.88) b0.001 1.45
Lower subscapularis 9.17(3.49) 10.87(5.91)
Eccentric Upper subscapularis 1.93(0.36) 1.87(0.52) b0.001a 1.46
Lower subscapularis 6.01(2.57) 6.12(4.86)
Total Upper subscapularis 2.26(2.88) 1.49(1.58) 0.071a 0.43
Lower subscapularis 10.23(14.57) 3.43(12.59)
a
External rotation Total Upper subscapularis 3.73(3.38) 2.24(3.23) 0.831 0.03
Lower subscapularis 9.10(16.97) 2.30(7.47)
b
Internal rotation Total Upper subscapularis 44.46(17.19) 45.64(26.01) 0.836 1.04
Lower subscapularis 43.32(18.31) 42.89(23.65)

Bold indicates significant P-value.

SD = Standard deviation.
IQR = Inter-quartile range.
a
Derived from a Wilcoxon signed-rank test.
b
Derived from a paired t-test.

respectively. The time to peak (accelerometer) is shown as a solid line
on both ensembles. During abduction, the peak movement occurred at
4.10 s and at 51% of the movement duration, whereas during flexion,
time to peak of the accelerometer was earlier, 3.96 s and 49.5% of the
movement duration. During abduction, two peaks in the upper and
lower subscapularis muscle activities occurred throughout mid-range
abduction and adduction (at approximately 30% and 70% of the duration
of the movement). During flexion, although not significant (P = 0.07)
differences in the upper and lower subscapularis activities are apparent,
however, the upper subscapularis was below the accepted minimum
detectable level (b 10% MVIC) throughout the entirety of the movement
(Brown et al., 2007).
Overall, the lower subscapularis activated at a higher level than the
upper subscapularis during abduction, flexion and external rotation
movements (Table 1). However, significant differences were identified
only during abduction (P = 0.018, ES = 0.56), with a trend towards sig-
nificance in the flexion movement (Fig. 3b). During internal rotation,
the high %MVIC in upper subscapularis mirrored that of lower
subscapularis, with a mean difference of only 1.14%.
Further analysing the concentric and eccentric phases of abduction,
differences in the upper and lower subscapularis activities were identi-
fied (P b 0.001) with effect sizes of 1.43 and 1.41 respectively. Similarly,
significant differences were seen in the concentric (P b 0.001; ES =
1.45), and eccentric phases (P b 0.001; ES = 1.46) of flexion.
Temporal characteristics (onset and termination) between the two
segments for abduction were compared (Table 2). Temporal data during
the flexion motion were not compared due to the minimal detectable
activity of subscapularis. Muscle onset data revealed that neither
upper nor lower segments were active prior to the abduction move-
ment commencing, as indicated by positive values. However upper
subscapularis activated significantly later than lower subscapularis
(P = 0.018). There was no difference in the point in the movement
where termination of muscle activity occurred.
Extension, internal rotation and horizontal flexion MVICs produced
the greatest muscle activity in the upper and lower subscapularis.
Box-plots illustrating the amplitude of muscle activity between upper
subscapularis (US) and lower subscapularis (LS) during these MVIC ac-
tions are shown in Fig. 4. No statistically significant differences were
found between the two portions of subscapularis.

4. Discussion

Fig. 3. Grand ensemble curves for upper and lower subscapularis during abduction (a) and
flexion (b).
This study has shown that there is significantly greater muscle activ-
ity in the lower subscapularis in comparison to the upper subscapularis
during abduction and flexion in a normal population. Additionally,
lower subscapularis activated significantly earlier than the upper
segment in abduction. This may indicate different roles for each
 J. Wickham et al. / Clinical Biomechanics 29 (2014) 885–891
Table 2
Onset and termination during dynamic shoulder abduction in seconds.
Temporal measure Upper subscapularis
Mean (SD)
Onset (seconds) 0.558(0.33)
Termination (degrees) 16.3(9.4)
SD = Standard deviation.
a
Derived from a Wilcoxon signed-rank test.
b
Derived from a paired t-test.
segment during some shoulder motions and a different functional role
in the initiation of movement.
The increased lower subscapularis activity during elevation might be
attributed to its greater role in resisting the superior shear force of the
deltoid. The line of pull of the inferior segment of the subscapularis is
considered to facilitate greater humeral head depression when com-
pared with the upper segment (Halder et al., 2000). During flexion in
the current study, upper subscapularis was found to be minimally active
according to the classification system used in Yamaguchi et al. (1997).
This is supported by the results of Collin et al. (2013) who found partic-
ipants with a muscle tear in their supraspinatus and their upper
subscapularis, had near full range of movement into forward flexion
(177.5°), however, those who had a tear in supraspinatus and both
their upper and lower subscapularis, had a reduced forward flexion of
83.0°. The significant loss of range identified by Collin et al. (2013)
and the increase in lower subscapularis muscle activity in the current
study might be attributed to its role in preserving forward flexion by
maintaining humeral head centralisation.
In addition to the lower subscapularis role of humeral head depres-
sor, when the arm is positioned in the middle ranges of abduction the
inferior portion of the subscapularis is positioned anterosuperiorly and
contributes the majority of resistance to anterior translation (Halder
et al., 2000). This could also explain the greater muscle activity
identified in the lower segment in the middle of the concentric and ec-
centric abduction phases and the large effect sizes between the muscles.
The two distinct bursts of activity are likely to be due to the anterior and
posterior rotators working in a co-ordinated manner to maintain
dynamic stability of the glenohumeral joint through the middle range
of the movement (Halder et al., 2000, Reinold et al., 2007).
Cadaveric modelling has also identified that the superior portion of
the subscapularis muscle is thicker, has a larger abduction moment
arm, and can generate greater abduction torque than the inferior
portion (Klapper et al., 1992, Otis et al., 1994). Whereas, the lower
subscapularis produces a large amount of muscle force with a smaller
moment arm to enhance the dynamic stability of the joint (DePalma
et al., 1967, Otis et al., 1994). Thus, it could be theorised that upper
Fig. 4. Box-plots illustrating differences between upper subscapularis (US) and lower subscapularis (LS) during MVIC actions. Box-plots represent median (solid line), inter-quartile range
(edge of the box), and range (upper and lower whisker). ES, effect size.
889
Lower subscapularis P-value Effect size
Mean (SD)
0.290(0.16) 0.018a 1.40
19.0(12.2) 0.593b 1.63
subscapularis acts in a similar manner to supraspinatus during eleva-
tion, whereby a large moment arm allows for greater torque production
with a smaller amount of force.
Overall the lower subscapularis appears to play a substantial role in
the normal functioning of shoulder elevation and this has implications
for clinical practice. The inferior portion of the muscle is considered to
be mechanically weak (Halder et al., 2000), and more susceptible to in-
jury (Piasecki and Nicholson, 2008), and injury to this segment results
in greater functional limitations (Collin et al., 2013).
Both segments of the subscapularis were markedly active
(Yamaguchi et al., 1997) during the extension MVIC. This supports the
role of the subscapularis in providing a dynamic buttress on the anterior
aspect of the joint to counterbalance powerful posterior muscle activity
(DePalma et al., 1967). The markedly active results during internal
rotation and moderate to moderately strong activity during horizontal
flexion MVICs support the belief that subscapularis is a prime mover
during these movements.
Onset and termination data showed lower subscapularis to activate
significantly earlier than upper subscapularis during abduction. The ear-
lier activation may reflect the lower segments' greater role in humeral
head centralisation. It could be hypothesised that the muscle activates
earlier in readiness to counteract the shear force of the deltoid. A
number of studies have examined the temporal characteristics of
subscapularis during various movements and activities (Decker et al.,
2003, Mulroy et al., 1996), however, only one differentiated timing
between the upper and lower subscapularis (O'Connell et al., 2006).
Contrary to the results of this study, O'Connell et al. (2006) found
upper subscapularis to activate significantly earlier than lower
subscapularis with a mean latency of 1.26 s between the portions.
Whether these differences were found solely during flexion, abduction
or both movements combined was not indicated. Additionally, differ-
ences in results may be due to small sample size (six) and limited num-
ber of repetitions (three) analysed in the study by O'Connell et al.
(2006).
Furthermore, O'Connell et al. (2006) reported greater muscle activi-
ty in upper subscapularis in five out of six participants during abduction,
890 J. Wickham et al. / Clinical Biomechanics 29 (2014) 885–891
scaption, and flexion in the sagittal planes. However, differences were
not statistically compared and cannot be assumed to be significantly
different. In fact, one of the six participants had the opposite result,
where higher activity was seen in the lower portion of subscapularis
during elevation — indicating that the natural variability could have a
substantial influence on results with a small sample. In comparison to
the current study, electrode insertions were based on a protocol by
Kadaba et al. (1992) and participants completed only three repetitions
of each movement at an unknown speed of motion with no resistance.
The findings of the current study add to the confusing picture of the
differing roles of the muscle segments in internal rotation. No difference
was found between the upper and lower segments during an isokinetic
internal rotation movement at 90° of abduction in this study and during
an isometric contraction in the same position. In comparison, Decker
et al. (2003) found the greatest upper subscapularis muscle activity dur-
ing internal rotation at 90° of abduction, while Kadaba et al. found the
opposite, with upper subscapularis decreasing significantly in activity
throughout the abduction movement from 0 to 90° and generally
performing at a smaller amplitude than lower subscapularis. The
varying rotation motions may have produced the differing results —
participants in the study by Kadaba et al. (1992) completed one isomet-
ric contraction; Decker et al. (2003), completed ten isotonic repetitions
against an elastic resistance band and those in the current study com-
pleted ten isokinetic repetitions and also an internal rotation MVIC. In
addition, a different methologies method of electrode positioning
was described in this study compared to that of Kadaba et al. (1992)
and Decker et al. (2003) who inserted their electrodes from the medial
border of the scapula rather than the lateral border.
Differences in muscle activity between the upper and lower
subscapularis found in this study support the theory that the broad or-
igins of both the infraspinatus and subscapularis muscles may be sug-
gestive of different actions for the inferior and superior portions of
these muscles (Liu et al., 1997). Recently, a similar finding in the mus-
cles of the shoulder was highlighted in a study by Hughes et al. (2014)
using functional testing to differentiate the roles of the two heads of
infraspinatus. They found that the oblique part of infraspinatus was
‘markedly active’ (N 50% MVIC) in all positions while the transverse
part was mostly ‘moderately active’ (21–35% MVIC) based on the
grading protocol published by Yamaguchi et al. (1997).
4.1. Limitations of the study
To date, two methods of electrode insertion into the upper and
lower subscapularis have been described (Kadaba et al., 1992, Nemeth
et al., 1990), however neither has been verified. The current study as-
sumed the electrodes to be situated in separate portions of the muscle
and although not confirmed, the differing activation patterns provide
some evidence for this assumption. The inherent subjectivity of EMG
analysis is also a potential limitation, however the testing procedures
(rs = 0.885) and data analysis methods (ICC = 0.98) utilised in the cur-
rent study have previously been shown to be reliable (Wickham et al.,
2010).
4.2. Future investigation
Future research should investigate if differences found between the
upper and lower subscapularis also exist in a population with rotator
cuff muscle dysfunction. In addition, considering the conflicting
evidence for the role of upper versus lower subscapularis, cadaveric re-
search could be undertaken to confirm that placement of electrodes into
uniquely directed fibres of the muscle is accurate (Suenaga et al., 2003).
5. Conclusions
The lower subscapularis activates at a significantly higher level com-
pared to upper subscapularis during abduction and flexion in a normal
population and likely reflects its greater role as a humeral head depres-
sor and anterior stabiliser. No differences were found between superior
and inferior components of subscapularis during internal and external
rotation. These differences have potential implications for the interpre-
tation of studies of subscapularis activity and function and for the devel-
opment and prescription of rehabilitation exercises. The role of the
different segments needs further analysis since there is limited agree-
ment between studies to date.
Conflict of interest statement
None of the authors of the above manuscript has declared any
conflict of interest that may arise from being named as an author on
the manuscript. There are no known conflicts of interest.
Acknowledgements
No funding was received for the completion of this study.
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