Scapular dyskinesis and its relation to shoulder pain.

Medical Director, Lexington Sports Medicine Center, Lexington, KY 40504, USA.
The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.4). 01/2003; 11(2):142-51.
Source: PubMed

ABSTRACT Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. 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. It may increase the functional deficit associated with shoulder injury by altering the normal scapular role during coupled scapulohumeral motions. Scapular dyskinesis appears to be a nonspecific response to shoulder dysfunction because no specific pattern of dyskinesis is associated with a specific shoulder diagnosis. It should be suspected in patients with shoulder injury and can be identified and classified by specific physical examination. Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain-based rehabilitation protocols.

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    ABSTRACT: The aim of this research was to investigate which shoulder abduction angle (30°, 90°, 150°) during shrug exercise is superior for 1) activating the scapular upward rotators and 2) improving scapular and clavicular position in subjects with scapular downward rotation impairment. Twenty subjects performed shrug exercises at three different shoulder abduction angles (30°, 90°, 150°) which were obtained and maintained actively. Surface EMG data were collected from the levator scapulae (LS), upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) during shrug exercises. Scapular downward rotation index (SDRI) and clavicular tilt angle (CTA) were measured immediately after each shrug exercise. Oneway repeated-measures analysis of variance was used to determine the significance. UT muscle activity was greater at 90° and 150° than at 30° of shoulder abduction. UT/LS muscle activity ratio was greater at 90° than at 30°. LT and LT/LS increased as shoulder abduction angle increased. SA was greater at 150° than at 30° or 90°. SA/LS was greater at 150° than at 30°. SDRI was lower at 90° and 150° than at 30°. CTA was greater at 90° and 150° than at 30°. In conclusion, shrug exercises at 90° or 150° of shoulder abduction angle may be advocated to activate scapular upward rotators, decrease SDRI, and increase CTA in patients with scapular downward rotation impairment.
    Journal of Electromyography and Kinesiology 01/2015; · 1.73 Impact Factor
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    ABSTRACT: It is proposed that altered scapular muscle function can contribute to abnormal loading of the cervical spine. However, it is not clear if patients with idiopathic neck pain show altered activity of the scapular muscles. The aim of this paper was to systematically review the literature regarding the differences or similarities in scapular muscle activity, measured by electromyography (=EMG), between patients with chronic idiopathic neck pain compared to pain-free controls. Case-control (neck pain/healthy) studies investigating scapular muscle EMG activity (amplitude, timing and fatigue parameters) were searched in Pubmed and Web of Science. 25 articles were included in the systematic review. During rest and activities below shoulder height, no clear differences in mean Upper Trapezius (=UT) EMG activity exist between patients with idiopathic neck pain and a healthy control group. During overhead activities, no conclusion for scapular EMG amplitude can be drawn as a large variation of results were reported. Adaptation strategies during overhead tasks are not the same between studies. Only one study investigated timing of the scapular muscles and found a delayed onset and shorter duration of the SA during elevation in patients with idiopathic neck pain. For scapular muscle fatigue, no definite conclusions can be made as a wide variation and conflicting results are reported. Further high quality EMG research on scapular muscles (broader than the UT) is necessary to understand/draw conclusions on how scapular muscles react in the presence of idiopathic neck pain. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    ABSTRACT: Background Shoulder pain is the third most common musculoskeletal disorder, often affecting people¿s daily living and work capacity. The most common shoulder disorder is the subacromial impingement syndrome (SIS) which, among other pathophysiological changes, is often characterised by rotator cuff tendinopathy. Exercise is often considered the primary treatment option for rotator cuff tendinopathy, but there is no consensus on which exercise strategy is the most effective. As eccentric and high-load strength training have been shown to have a positive effect on patella and Achilles tendinopathy, the aim of this trial is to compare the efficacy of progressive high-load exercises with traditional low-load exercises in patients with rotator cuff tendinopathy.Methods/DesignThe current study is a randomised, participant- and assessor-blinded, controlled multicentre trial. A total of 260 patients with rotator cuff tendinopathy will be recruited from three outpatient shoulder departments in Denmark, and randomised to either 12 weeks of progressive high-load strength training or to general low-load exercises. Patients will receive six individually guided exercise sessions with a physiotherapist and perform home-based exercises three times a week. The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.DiscussionPrevious studies of exercise treatment for SIS have not differentiated between subgroups of SIS and have often had methodological flaws, making it difficult to specifically design target treatment for patients diagnosed with SIS. Therefore, it was considered important to focus on a subgroup such as tendinopathy, with a specific tailored intervention strategy based on evidence from other regions of the body, and to clearly describe the intervention in a methodologically strong study.Trial registrationThe trial was registered with (NCT01984203) on 31 October 2013.
    Trials. 01/2015; 16(1):27.