Effectiveness of scapular clock exercises in scapular dyskinesia in post operative cardiac patients: A randomized clinical trial

Background: Scapular dyskinesia is a frequent complication after cardiac surgery due to thoracic immobility, pectoral tightness, and muscle imbalances, contributing to persistent shoulder pain and functional deficits. Objective: To evaluate the effectiveness of scapular clock exercises combined with conventional physiotherapy versus conventional physiotherapy alone in reducing pain, improving range of motion (ROM), and enhancing shoulder function in post-operative cardiac patients. Material and Methods: This randomized clinical trial included n=28 post-cardiac surgery patients with scapular dyskinesia, who were allocated to either Group A (scapular clock exercises plus conventional physiotherapy) or Group B (conventional physiotherapy). Both groups were treated thrice weekly for 4 weeks. The primary outcome was the Numeric Pain Rating Scale (NPRS), and secondary outcomes included QuickDASH and shoulder ROM. Statistical analysis was conducted using RM-ANOVA and independent t-tests. Results: The mean age of n=17(60%) male and n=11(40%) female subjects were 55.21±7 years. Both groups significantly improved pain, disability, and ROM over 4 weeks (p<0.05). Group A demonstrated markedly greater improvements in NPRS, QuickDASH, and all ROM directions at 2- and 4-week follow-ups compared to Group B, with large effect sizes. Conclusion: Scapular clock exercises combined with conventional physiotherapy offer superior outcomes for pain, disability, and mobility compared to conventional physiotherapy alone. These findings highlight the importance of incorporating targeted scapular exercises into cardiac rehabilitation to address under-recognized musculoskeletal deficits. Keywords: scapular clock exercises; postoperative rehabilitation; numeric pain rating scale (NPRS); quickdash; resistance training; post sternotomy complications; physiotherapy; upper limb function.