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Scapular Dyskinesis
From WikiSM
Other Names
- Scapular Dyskinesia
- Scapulothoracic Dyskinesis
- SICK Scapula Syndrome
- Scapular Malpositioning, Inferior medial border prominence, Coracoid pain and malposition and DysKinesis of scapular movement
- Scapular Dysfunction
Background
- This page refers to dyskinesis or dyskinesia of the Scapula
- Considered non-specific response to a painful shoulder condition rather than a specific response to certain glenohumeral pathology
Epidemiology
- Present in as many as 67% to 100% of athletes with shoulder injuries[1]
Pathophysiology
- Role of scapula[2]
- Provides synchronous scapular rotation during humeral motion
- Serves as a stable base for Rotator Cuff activation
- Functions as a link in the kinetic chain
- Scapular dyskinesis definition[3]
- 1: Abnormal static scapular position and/or dynamic scapular motion characterized by medial border prominence
- 2: Inferior angle prominence and/or early scapular elevation or shrugging on arm elevation; and/or
- 3: Rapid downward rotation during arm lowering
Etiology
- Injuries that predispose you to developing scapular dyskinesis:
- Acromioclavicular Joint Separation
- Clavicle Fracture
- Rotator Cuff Tear
- Rotator Cuff Tendonitis
- Calcific Tendinitis of the Rotator Cuff
- Shoulder Instability
- Glenoid Labral Tears
- Poor throwing mechanics
- Pathologic Kyphosis
- Neurologic injuries (eg, long thoracic, accessory, or dorsal scapular nerve palsies)
- Acromioclavicular Joint Pain
- Winged Scapula
- Adhesive Capsulitis
Pathoanatomy
- Primary Stabilizers
- Secondary Stabilizers
- Scapulothoracic power imbalance leads to protracted scapula
- Alteration of shoulder mechanics and can cause secondary injuries
Risk Factors
- Overhead athletes[4]
Differential Diagnosis
- Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Dislocations & Separations
- Arthropathies
- Muscle & Tendon Injuries
- Rotator Cuff
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)
Clinical Features
- History
- (Needs to be updated)
- Physical Exam: Physical Exam Shoulder
- Scapular exam done primarily posteriorly with shirt removed (if possible) for complete visualization
- Important to evaluate resting posture checking for for side-to-side asymmetry, especially inferior or medial border prominence
- Evaluate dynamic scapula position by slow ascent-descent of shoulder 3-5 times
- Special Tests
- Scapular Assistance Test: Support the scapula with forward flexion of the shoulder
- Scapular Retraction Test: Retract the scapula manually after motor exam of supraspinatus
- Lateral Scapular Slide Test: measure scapular position with arms in different positions
- Isometric Pinch Test: "Pinch" scapula together
Evaluation
- Primarily a clinical diagnosis
- Standard Radiographs Shoulder and other imaging can be used to identify primary diagnosis
Classification
Kibler Classification
- Type I or Inferior dysfunction[5]
- Primary external visual feature is the prominence of the inferior angle
- Most commonly found in patients with rotator cuff dysfunction.
- Type 2 or Medial dysfunction
- Primary external visual feature is the prominence of the entire medial scapular border
- Medial pattern dysfunction most often occurs in patients with glenohumeral joint instability.
- Type 3 or Superior dysfunction
- Characterized by excessive and early elevation of the scapula during upper extremity elevation.
- Most often seen in patients with rotator cuff dysfunction and deltoid-rotator cuff force couple imbalances
Management
Nonoperative
- First line treatment
- Primary treatment is directed at the underlying pathology
- Activity modification
- Including correcting of throwing mechanics
- Medications including NSAIDS
- Physical Therapy
- Emphasis on core strengthening, scapular stabilizers, rotator cuff, serratus anterior
- Corticosteroid Injection
Operative
- Indicated only if primary injury or pathology is considered surgical
Rehab & Return to Play
Rehab
- Emphasis[6]
- Core strenghtening
- Scapular stabilizers
- Rotator Cuff
- Serratus Anterior
- Trapezius, especially lower 1/3
Return to Play
- Needs to be updated
Complications
- Needs to be updated
See Also
- Internal
- External
- Sports Medicine Review Shoulder Pain: https://www.sportsmedreview.com/by-joint/shoulder/
References
- ↑ Pluim BM. Scapular dyskinesis: practical applications. Br J Sports Med. 2013;47:875–876.
- ↑ Kibler, W. Ben, and Aaron Sciascia. "Current concepts: scapular dyskinesis." British journal of sports medicine 44.5 (2010): 300-305.
- ↑ Second Scapula Summit. Unpublished consensus statement. Lexington, Kentucky, USA. 20 July 2006
- ↑ Matthew B. Burn, Patrick C. McCulloch, David M. Lintner, Shari R. Liberman, and Joshua D. Harris Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes: A Systematic Review Orthopaedic Journal of Sports Medicine February 2016 vol. 4 no. 2
- ↑ Kibler WB et al.Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg.2002;11:550-556
- ↑ Cools, Ann MJ, et al. "Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete." Br J Sports Med 48.8 (2014): 692-697.
Created by:
John Kiel on 7 July 2019 23:42:13
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Last edited:
1 October 2022 19:08:43
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