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: 2.53). 03/2003; 11(2):142-51.
Source: PubMed


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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    • "In addition, all muscles lengths estimated through simulation were based on glenohumeral kinematics recorded on healthy subjects, while relative contribution of glenohumeral joint is known to vary in compensation for shoulder injury during active arm elevation (Ben Kibler and McMullen, 2003). Hence, thoracohumeral results proposed in appendix may be underestimated, as thoracohumeral–glenohumeral elevation ratio in patients may be increased. "
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    ABSTRACT: Despite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity. Mechanical stresses to failure of repaired tendons have been reported. While optimal immobilization postures were proposed to minimize this stress, post-operative rehabilitation protocols have never been assessed with respect to these values. Purpose was to use musculoskeletal simulation to predict when the stress in repaired tendons exceeds safety limits during passive movements. Hence, guidelines could be provided towards safer post-operative exercises. Sixteen healthy participants volunteered in passive three-dimensional shoulder range-of-motion and passive rehabilitation exercises assessment. Stress in all rotator cuff tendons was predicted during each movement by means of a musculoskeletal model using simulations with different type and size of tears. Safety stress thresholds were defined based on repaired tendon loads to failure reported in the literature and used to discriminate safe from unsafe ranges-of-motion. Increased tear size and multiple tendons tear decreased safe range-of-motion. Mostly, glenohumeral elevations below 38°, above 65°, or performed with the arm held in internal rotation cause excessive stresses in most types and sizes of injury during abduction, scaption or flexion. Larger safe amplitudes of elevation are found in scapular plane for supraspinatus alone, supraspinatus plus infraspinatus, and supraspinatus plus subscapularis tears. This study reinforces that passive early rehabilitation exercises could contribute to re-tear due to excessive stresses. Recommendations arising from this study, for instance to keep the arm externally rotated during elevation in case of supraspinatus or supraspinatus plus infraspinatus tear, could help prevent re-tear. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
    Clinical biomechanics (Bristol, Avon) 08/2015; DOI:10.1016/j.clinbiomech.2015.08.006 · 1.97 Impact Factor
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    • "For example, Warner et al. [8] reported this association in 14 of their 22 patients with shoulder instability and in all of their seven patients with subacromial impingement. In two other studies, scapular dyskinesis was observed in 15 out of 15 patients with glenohumeral instability [22] [23]. The 72 patients with scapular muscle detachment described by Kibler et al. [18] did not have glenohumeral instability. "
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    ABSTRACT: We report the case of a 28-year-old transgender (male-to-female) patient that had a partial tear of the rhomboid major tendon, scapulothoracic bursitis, and glenohumeral instability on the same side. These conditions resulted from traumatic events during circus acrobatic maneuvers. Additional aspects of this case that make it unique include (1) the main traumatic event occurred during a flagpole exercise, where the patient's trunk was suspended horizontally while a vertical pole was grasped with both hands, (2) headaches were associated with the periscapular injury and they improved after scapulothoracic bursectomy and rhomboid tendon repair, (3) surgical correction was done during the same operation with an open anterior capsular-labral reconstruction, open scapulothoracic bursectomy without bone resection, and rhomboid tendon repair, (4) a postoperative complication of tearing of the serratus anterior and rhomboid muscle attachments with recurrent scapulothoracic pain occurred from patient noncompliance, and (5) the postoperative complication was surgically corrected and ultimately resulted in an excellent outcome at the one-year final follow-up.
    08/2015; 2015:302850. DOI:10.1155/2015/302850
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    • "Despite the advantages offered by the three-dimensional dyskinesis method, however, it does not easily enable measurement mainly because it is too expensive and the equipment is excessively bulky. Given that clinicians could not use this approach, they typically employ Kibler's observational typing method, which was considered the gold standard in clinical examinations (Kibler & McMullen, 2003; Uhl, Kibler, Gecewich, & Tripp, 2009). Nevertheless, even though Kibler's observational typing method is practical, the current study opted to measure scapular anterior tilting (scapular anterior tilting index) and the scapular upward rotation angle. "
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