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Scapular Dyskinesis

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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

Pathoanatomy


Risk Factors

  • Overhead athletes[4]

Differential Diagnosis


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

Evaluation


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

Return to Play

  • Needs to be updated

Complications

  • Needs to be updated

See Also


References

  1. Pluim BM. Scapular dyskinesis: practical applications. Br J Sports Med. 2013;47:875–876.
  2. Kibler, W. Ben, and Aaron Sciascia. "Current concepts: scapular dyskinesis." British journal of sports medicine 44.5 (2010): 300-305.
  3. Second Scapula Summit. Unpublished consensus statement. Lexington, Kentucky, USA. 20 July 2006
  4. 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
  5. Kibler WB et al.Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg.2002;11:550-556
  6. 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:
12 April 2022 17:01:53
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