These three real-life case studies illustrate how objective shoulder screening using EMG can be applied: from a pulley lesion in an elderly patient to a SLAP injury in elite sports. With just a few measurements, EMG visualises muscle activity that would otherwise remain hidden – laying the foundation for personalised therapy, effective training, and sustainable prevention.
EMG – Measuring Muscle Activity
While X-rays and MRIs are widely regarded as the gold standard in today’s healthcare system, EMG (electromyography) is still relatively unknown in many circles. EMG is not a classic imaging tool but a functional measurement method that captures the electrical activity of muscles in real time. It allows clinicians to detect muscular imbalances and automatically generate individualised treatment plans. Since muscle activity and neuromuscular control cannot be palpated, EMG offers a way to objectively confirm or disprove hypotheses about underlying dysfunctions. In doing so, EMG can complement any diagnostic process without fundamentally altering existing protocols.
Shoulder Screening in 3 Minutes
EMG can visualise muscle activity both at rest and during movement or exercise. The myoact system can measure 36 surface-accessible muscles, including key stabilisers of the shoulder such as the upper, middle, and lower trapezius, infraspinatus, portions of the pectoralis major, the biceps brachii, triceps brachii, serratus anterior, and the deltoid (anterior, middle, posterior). Mapping one of these muscles includes assessing resting tone, voluntary and involuntary activity, and takes roughly 3 minutes. The resulting report compares findings to normative values, highlights imbalances, and suggests corrective exercises.
Case Study: Pulley Lesion at Age 74
Our first case is a 74-year-old patient who presented three months post-op following a pulley lesion on his left shoulder. He was unable to lift his arm higher than 100 degrees. Due to a prior sepsis and a temporary stoma, many motor patterns had been lost and training options were limited. Initial EMG mapping of the upper trapezius revealed abnormal resting tone on both the healthy right and the operated left side. In the myoact app, these values were flagged as suboptimal (red zone). Even during simple tasks such as “lift your shoulders,” the data showed a 60%+ asymmetry, with movements of the left arm being largely compensated by the right. Mapping exercises involving abduction and flexion revealed even greater imbalances over 80% and clear signs of overuse on the right side. Similar patterns were observed in the lower trapezius, where the left anterior deltoid tried to compensate for the underactive trapezius with excessive activation.
You can also view all the details of the case described here in the recording of the case study webinar.
Mapping as the Foundation for Therapy
The further course of therapy was determined on the basis of the initial mapping. Early treatment focused on retraining motor control in a standing position. Additionally, biofeedback training using cable machines was implemented. Biofeedback in this context means that patients visually monitor muscle activity in real time during exercise, allowing for constant adjustments and improved control. Manual mobilisation of the posterior glenohumeral capsule and the thoracic spine complemented the approach. To reduce hyperactivity in the anterior deltoid, radial shockwave therapy was applied to that specific muscle region.
Retest after 5 Months
After five months of consistent training and adjunct therapies, a follow-up EMG test showed promising results. The upper trapezius still exhibited a slight baseline tone on both sides, but the right-side overactivation had been significantly reduced, and left-side activation markedly improved. The resulting balance score of 84% reflected a more economical and symmetrical movement pattern. The therapeutic goal had never been to maximise activation at all costs but rather to restore an age-appropriate, efficient movement strategy. Resting tone in the lower trapezius also decreased, and voluntary activation on the left side improved significantly, though some right-side compensation remained. This progress was attributed not only to biofeedback training but also to shockwave therapy, which helped decrease overreliance on the anterior deltoid.
Case Study: Supraspinatus Refixation at Age 81
This patient began therapy around three months after undergoing supraspinatus tendon refixation. At intake, he was unable to raise his arm past 90 degrees. Since there were no structural limitations to his range of motion, therapy focused entirely on active interventions. The lower trapezius was specifically assessed and targeted to improve scapular setting, i.e. the ability to control and position the shoulder blade. Both the healthy left and the operated right side initially showed very low muscle activity. Training strategies included cable machines, kettlebell exercises, and focused neuromuscular reactivation. After 20 weeks, significant improvements were recorded, with activity levels rising up to 150–200 microvolts on both sides.
Case Study: Professional Athlete, 27, SLAP Lesion
Our next case involves Dominik Ressel, a world-class judo athlete. While preparing for the 2020 Olympic Games, a SLAP lesion caused biceps instability. After the Games were postponed to 2021, he underwent surgery. However, the intervention led to a biceps tenodesis, which resulted in a severe internal rotation deficit – a major problem given the importance of this motion in his judo technique. His everyday life as a police officer was also affected: he could no longer reach his baton with the injured left arm.
EMG as the Method of Choice
Despite receiving neural therapy, shockwave treatment, and daily rehab sessions, his progress was modest with around 50% improvement. That’s when EMG mapping was introduced. The first mapping revealed asymmetry in the trapezius: on the healthy right side, he could actively control scapular movement, while on the affected left side, co-contraction occurred, i.e. a simultaneous, non-specific contraction of multiple muscles. This indicated a disrupted mind-muscle connection. There were no structural restrictions such as GIRD or internal rotation deficit. However, video footage from training sessions and further EMG mapping pointed to a functional problem: during pull-ups, Ressel over-activated his pectoralis major, even more so than his lower trapezius – an unmistakable sign of muscular compensation.
Training Adjustments and Visual Feedback
Further analysis of exercises confirmed excessive chest muscle activity. Training was then adapted accordingly: exercises targeting the pectoralis major were scaled back, while emphasis was placed on activating the trapezius as a posterior chain counterbalance. Using EMG biofeedback, he could visually monitor muscle activity in real time during exercises. This made it possible to ensure that the trapezius was more active than the pectoralis major, especially during movements like pull-ups. These targeted adjustments enabled Ressel to participate in the 2021 Olympic Games, where he won bronze in the team competition and even defeated the reigning world champion.
Conclusion
EMG shoulder screenings allow clinicians to visualise and treat muscular imbalances with precision. The upper and lower trapezius muscles in particular play a key role and should always be included in initial assessments. Whether following surgery, in chronic cases, or at the elite level – hypotheses can be validated with EMG and followed by focused therapy. EMG can also be applied preventively, helping to avoid injury, enhance performance, strengthen the mind-muscle connection, and promote more economical movement patterns.
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