When the scapula moves coordinately the humerus maintaining the axis of rotation of the humerus is called the scapulohumeral rhythm. Many authors assert that abnormal scapular motion, socalled dyskinesis, is related to shoulder injury, but evidence from 3dimensional measurement studies regarding this relationship. Shoulder instability represents a spectrum of disorders resulting in shoulder dysfunction, including subluxation, dislocation, and symptomatic laxity. In most cases, alterations of the scapula can be seen by looking at the patient from behind.
In the case of abnormal scapula movement, commonly known as scapular dyskinesis, scapulohumeral rhythm is disrupted and can cause problems such as discomfort, shoulder pain and impingements as well as being an indication of some kind of shoulder disorder. The only connection between scapula and axial skeleton is acromioclavicular joint. Many authors assert that abnormal scapular motion, socalled dyskinesis, is related to shoulder injury, but evidence from 3dimensional measurement studies regarding this relationship is mixed. Scapular dyskinesis and its relation to shoulder injury abstract the scapula plays a key role in nearly every aspect of normal shoulder function. Scapular dyskinesis in young, asymptomatic elite swimmers. Primary scapular presentations such as scapular winging and snapping should be managed with a. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff. Scapular dyskinesis may be found in association with many types of shoulder pathologies,28 29 although the exact relation ship between dyskinesis and clinical pathology is not clear. On its own, scapular dyskinesis is neither an injury nor musculoskeletal disorder 8.
With current research on shoulder pathologies, there is a link between scapular dyskinesis and shoulder conditions such as rotator cuff pathologies, glenohumeral instability, acromioclavicular joint injuries. There are 3 types of scapular dyskinesis that will disrupt the scapular movement pattern. Most of the abnormal biomechanics and overuse injuries that occur about the shoulder girdle may be traced to alterations in the function of the scapularstabilizing muscles. The presence or absence of scapular dyskinesis needs to be determined during the clinical examination.
Pdf scapular dyskinesis and its relation to shoulder pain. Pdf scapular dyskinesis and its relation to shoulder injury. Scapular dyskinesis or scapular dysfunction refers to the abnormal mobility or function of the scapula shoulder blade. The main cause is muscle imbalance, between the trapezius, rhomboids, and pectoralis minor. Dyskinesis has been hypothesized to be a protective response to some glenohumeral joint pathologies kibler, w ben, et al. Scapular dyskinesis can be defined as a collective term that refers to movement of the scapula that is dysfunctional and may create a possible impairment of overall shoulder function, although it may also represent the cause of persistent shoulder symptoms or may be the manifestation of underlying structural shoulder pathology in many types of shoulder injury. Persons with associated conditions such as shoulder impingement, rotator cuff disease, labral injury, clavicle fracture, acromioclavicular joint injury, and multidirectional instability should be evaluated for. The next step is determining the relation of the observed dyskinesis to clinical symptoms. A sick scapula will result in scapular dyskinesis which is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. Review article scapular dyskinesis and its relation to. Scapular dyskinesis as assessed with the sdt is not more prevalent in those with shoulder pain. The scapula is overlooked for multiple reasons including a limited understanding of the complex muscular stabilization and motion of the scapula. The scapular movement in relation to humeral abduction and the corresponding muscle vectors that affect it. Although it occurs in a large number of shoulder injuries, it appears that scapular dyskinesis is a nonspeci.
Scapular dyskinesis scapular dyskinesis1 is defined as observable alterations in the position of the scapula and the patterns of scapular motion in relation to the thoracic cage. Jul 09, 2017 scapular dyskinesis altered scapular positioning and motionis found in association with most shoulder injuries. Therefore, the bone is primarily held in place by the attached and surrounding muscles. Scapular dyskinesia, the forgotten culprit of shoulder. It should be suspected in patients with shoulder injury and can be identified and classified by specific physical examination. Compared to conditions of the shoulder such as sub acromial impingement,28,29,31 few studies have explored the relationship between scapular dysfunction and neck pain. Basic science and clinical research findings have led to the identification of normal threedimensional scapular kinematics in scapulohumeral rhythm and to abnormal kinematics in shoulder injury. The role of the scapula in athletic shoulder function. Scapular dyskinesis and its relation to shoulder injury. Jul 21, 20 the american journal of sports medicine. Jan 01, 2018 background knowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball.
Clinical photograph demonstrating scapular windup as a result of glenohumeral internal rotation decit. Several factors may create these abnormal patterns and positions. In these cases, rehabilitation is the best treatment. The scapula and arm are connected to the body by multiple muscle and ligament attachments.
Scapular dyskinesis its relation to shoulder pain free download as powerpoint presentation. The sat is used in evaluating places the scapula in a retracted posi june 2012, vol 20, no 6 367 scapular dyskinesis and its relation to shoulder injury tion and manually stabilizes it, then tachment, the injury creates the dys may be a response to injury. The scapula is part of the glenohumeral and acromioclavicular joint, although actually, there is not a true scapulothoracic joint. Evaluation and management of scapular dyskinesis in. Scapular dyskinesis in relation to neck and shoulder pain. Kilber wb, mcullen j 2003 scapular dyskinesis and its relation to shoulder pain. Oct 26, 2018 the scapular waist comprises the scapula, clavicle, humerus and outer, together constitute the shoulder, a joint formed by 5 joints. Clinical implications of scapular dyskinesis in shoulder. Scapular dyskinesia are changes in position and scapular movements that predispose to shoulder injuries.
We present a case of a young male patient with dyskinesis due to axonal involvement of the long thoracic nerve and paresis of the. Scapular girdle movements can be described as scapula movements. Persons with associated conditions such as shoulder impingement, rotator cuff disease, labral injury, clavicle fracture, acromioclavicular joint injury, and multidirectional instability should be evaluated for scapular dyskinesis and. Scapular dyskinesis is the term used to describe loss of normal scapular physiology, biomechanics, and kinetics. Scapular dyskinesis and its relation to shoulder pain.
A clinical method for identifying scapular dyskinesis. Primary scapular presentations such as scapular winging and snapping should be managed with a protocol that is focused on. Scapular dyskinesis sd is currently defined as an alteration of normal scapular kinematics. It occurs in a large number of injuries involving the shoulder joint and often is caused by injuries that result in the inhibition or disorganization of activation patterns in scapular. Pdf scapular dyskinesis and its relation to shoulder. Scapular dyskinesis is quite frequent and can lead to shoulder pain. Scapular dyskinesis and shoulder injury pathoanatomy the clavicle largely exists to assist the scapula in shoulder function by helping maintain optimal scapular position during arm motion. Abstractthe scapula plays a key role in nearly every aspect of normal shoulder function. Scapular dyskinesis altered scapular positioning and motionis found in association with most shoulder injuries. Benjamin kibler and aaron sciascia and trevor wilkes, journalthe journal of the american academy of orthopaedic surgeons, year2012, volume20 6, pages 36472. It is still unclear whether it is the cause or an effect of shoulder injuries a compensatory mechanism for shoulder pathology. There is a body of evidence suggesting that patients with impingement symptoms and glenohumeral instability consistently show altered scapular kinematics.
Scapular dyskinesis appears to be a nonspecific response to shoulder dysfunction because no specific pattern of dyskinesis is associated with a specific shoulder diagnosis. Scapular dyskinesisaltered scapular positioning and motionis found in association with most shoulder injuries. Aim to investigate if an increase in handball load is associated with increased shoulder injury rates compared with a minor increase or decrease, and if an association is influenced by scapular control, isometric shoulder strength or. The areas covered included the scapula and shoulder injury, the scapula and sports participation, clinical evaluation and interventions and known outcomes. Rating was influenced by an examiners knowledge of shoulder pain presence. Muscle inhibition or weakness is quite common in glenohumeral pathology, whether from instability, labral pathology, or arthrosis. Bony posture or injury a resting posture of excessive thoracic kyphosis and increased cer. Scapular dyskinesis sick scapula the scapula is the large triangularshaped bone at the back of your shoulder frequently known as the shoulder blade. Scapular dyskinesis and its relation to shoulder pain 144 journal of the american academy of orthopaedic surgeons itive tensile use. Scapular shoulder blade problems and disorders orthoinfo. Clinical implications of scapular dyskinesis in shoulder injury. The scapular waist comprises the scapula and clavicle and together with the humerus and the external constitute the shoulder, a joint formed by 5 joints. The medical term for these alterations is scapular dyskinesis dys alteration of, kinesis movement. The causes of scapular dyskinesis can be split into three groups.
Clarsen b, bahr r, andersson sh, munk r, myklebust g. Journal of the american academy of orthopaedic surgeons. Scapular dysfunction in high school baseball players sustaining throwing related upper extremity injury. The medial inner border of the affected shoulder blade will appear more prominent than the one on the opposite side. Shoulder pain minneapolis scapular dyskinesis mn sports.
Aim to investigate if an increase in handball load is associated with increased shoulder injury rates compared with a minor increase or decrease, and if an association is influenced by scapular control, isometric shoulder strength or glenohumeral range of motion rom. This is often a very subtle abnormality and it typically is not a primary complaint by the patient. Scapular dyskinesis may be the cause or the result of a shoulder injury, exacerbate shoulder symptoms or adversely affect treatment or outcomes. Its only attachment to the rest of the skeleton is through the collarbone at the acromioclavicular joint. To correctly carry out the sat, assistance for scapular elevation is provided by manually stabilizing the scapula and rotating the inferior border. Basic science and clinical research findings have led to. Mcmullen, journalthe journal of the american academy of orthopaedic surgeons, year2003, volume11 2, pages 14251. Shoulder injuries are common in athletes involved in overhead sports, and scapular dyskinesis is believed to be one causative factor in these injuries. Scapular resting position, shoulder pain and function in. It occurs in a large number of injuries involving the shoulder joint and often is caused by injuries that result in the inhibition or disorganization of activation patterns in scapular stabilizing muscles.
The scapula plays a key role in nearly every aspect of normal shoulder function. The most common symptoms of scapular dyskinesis include. The shoulder consensus group agreed that scapular dyskinesis is an impairment of shoulder function and. Scapular dyskinesia and its relationship to rotator cuff. Clinical photograph demonstrating scapular dyskinesis in which the medial inferior angle is prominent and the scapular position is protracted and internally rotated. Basic science and clinical research findings have led to the identification of normal threedimensional scapular kinematics in scapulohumeral rhythm and to abnormal kinematics in shoulder injury, the development of clinical methods. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Shoulder instability, dysfunction and scapular dyskinesis. Assessment of scapular dyskinesis the sports physiotherapist. Major conclusions were 1 scapular dyskinesis is present in a high percentage of most shoulder injuries.
Scapular dyskinesis may represent normal movement variability. Pdf clinical implications of scapular dyskinesis in. Scapular dyskinesia, the forgotten culprit of shoulder pain. Despite the scapula s role as the platform for upper extremity motion, the scapula, scapulothoracic mechanics, and periscapular musculature are often overlooked in the routine workup of both the painful and the dysfunctional shoulder. Background knowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball. Scapular dyskinesis has a high association with labral injury. Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. Primary scapular presentations such as scapular winging and snapping should be managed with a protocol that is focused on the scapula. Scapular dyskinesis its relation to shoulder pain shoulder. The scapular assistance test sat and scapular retraction test srt are corrective maneuvers that can alter the injury symptoms and provide information about the role of scapular dyskinesis in the total picture of the dysfunction 11. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk. We present a case of a young male patient with dyskinesis due to axonal involvement of the long thoracic nerve and paresis of the anterior. The relevance of scapular dysfunction in neck pain.
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