Scapula Dyskinesis

Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction

Background and Objectives: Neck and shoulder injuries commonly occur during boxing, and scapular dyskinesis is related to those injuries. This study investigated scapular dyskinesis with neck disability and shoulder malfunction in elite boxers. Materials and Methods: Seventy-two elite boxers participated in this study. Scapular dyskinesis was evaluated as normal, subtle, and obvious. Neck disability index (NDI), shoulder internal (IR), and external (ER) range of motion (ROM), isometric strength of IR and ER, and pectoralis minor length were measured and compared with the severity of scapular dyskinesis. Results: Thirty-eight boxers (52.7%) showed scapular dyskinesis. NDI score was significantly different (normal = 3.89 ± 3.08, obvious = 7.36 ± 4.95, p = 0.025). Isometric IR strength was significantly different (normal = 10.48 ± 2.86, obvious = 8.46 ± 1.74, p = 0.01). The length of the pectoralis minor was significantly different (normal = 10.17 ± 0.67, subtle = 9.87 ± 0.79, obvious = 9.47 ± 0.85; p = 0.001), and the dominant and non-dominant arm IR ROM was significantly different (dominant = 57.43 ± 11.98, non-dominant = 64.62 ± 10.3, p = 0.001). Conclusions: The prevalence of scapular dyskinesis is high among elite boxers. Boxers with scapular dyskinesis presented shoulder malfunction as well as neck disability. Further investigation is necessary to examine the relationship between scapular dyskinesis and neck disability in boxers.

Scapular stabilization exercise based on the type of scapular dyskinesis versus traditional rehabilitation training in the treatment of periarthritis of the shoulder: study protocol for a randomized controlled trial

Background Periarthritis of the shoulder is a common disease leading to dysfunction of the shoulder joint and have a significant impact on patients’ daily life. Evidence shows that there is a close relationship between scapular dyskinesis (SD) and shoulder diseases. Scapular stabilization exercise has been proved to be efficacious in relieving pain and improving function. However, there is no targeted exercise based on the type of scapular dyskinesis. This study will investigate the potential of scapular stabilization exercise based on the type of scapular dyskinesis in treating periarthritis of the shoulder. Methods This study is a prospective, randomized controlled, parallel-group trial, intending to recruit 90 patients diagnosed with periarthritis of the shoulder. Patients will receive scapular stabilization exercise training based on the type of scapular dyskinesis or receive traditional rehabilitation training conducted for 30 min, once a day, for 6 weeks. The primary outcome is Constant-Murley score (CMS), and other outcomes include pain degree, range of motion (ROM), type of scapular dyskinesis, scapula position, and patients’ satisfaction with shoulder function. Assessments will be performed at baseline, 2-, 4- and 6-week treatment, and at the 6-week follow-up after the end of treatment. Discussion This study will be the first study to investigate the clinical efficacy of scapular stabilization exercise based on the type of scapular dyskinesis in patients with periarthritis of the shoulder. The results may provide evidence of the effect of targeted scapular stabilization exercise in improving shoulder function and correcting scapular dyskinesis, and provide valuable information for future research. Trial registration This study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2100044332 at March 14, 2021.

reliability of the scapular posture and scapular dyskinesis tests in rugby union players

OBJECTIVES: To determine the reliability of static scapular posture (SP), clavicular tilt angle (CTA) and the scapular dyskinesis (SD) assessments by expert and student therapists. DESIGN: inter-rater and intra-rater reliability study. SETTING: University level male rugby union club PARTICIPANTS: Four sport rehabilitation students and one experienced physiotherapist evaluated the position of the scapular and clavicle of male university-level rugby union players (inter-rater participants: session 1: n=17, session 2: n=12 and session 3: n=16; intra–rater participants: n = 12). MAIN OUTCOME MEASURESː Participants attended 3 testing sessions, each 1 week apart. Scapular orientation and motion were assessed in five planes of movement and using the Scapular Dyskinesis Test (SDT) respectively. RESULTSː Kappa coefficient values and percentage agreement ratings for students compared to the experienced therapist were: SP=poor to fair (-0.01-0.33), (27% - 94%); SDT=slight (0.16) (41%); CTA=fair (0.21) (59%). Test-retest (intra-rater) agreement was fair to moderate (0.22 – 0.44) (69% -95%), slight (0.12) (47%), and fair (0.39) (77%) for the SP, SDT, and CTA, respectively. CONCLUSIONSː Static and dynamic evaluation of the shoulder by students and an experienced therapist has poor to moderate reliability and should not be used to make clinical decisions based on observation alone.

The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge

Scapular dyskinesis can be present in healthy individuals as in patients with shoulder pathology. Altered patterns of scapular kinematics can cause or exacerbate rotator cuff tear pathology. However, more research is needed. Regardless of the cause or the consequence of rotator cuff tear, scapular dyskinesis impairs shoulder function, worsens the symptoms, and compromises the success of clinical intervention. The available literature suggests physical therapy as the first treatment for degenerative cuff tears, and scapular dyskinesis should be addressed if present. Non-responsive cases or traumatic tears may require surgery. Postsurgical physical therapy protocols after rotator cuff repair must consider scapular dyskinesia to improve the outcomes. Cite this article: EFORT Open Rev 2021;6:932-940. DOI: 10.1302/2058-5241.6.210043

Reaching higher: External scapula assistance can improve upper limb function in humans with irreversible scapula alata

Background Scapular dyskinesis, i.e., the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata—a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, i.e., non-invasive, scapula assistance is provided. Methods The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis. Results With therapist assistance, average arm elevation increased by 17.3° in flexion (p < 0.001, 95% confidence interval of the mean $$C{I}_{95\%}=\hspace{0.17em}\left[9.8^\circ , 24.9^\circ \right]$$ C I 95 % = 9 . 8 ∘ , 24 . 9 ∘ ), and by 11.2° in abduction (p < 0.01, $$C{I}_{95\%}=\left[4.7^\circ , 17.7^\circ \right]$$ C I 95 % = 4 . 7 ∘ , 17 . 7 ∘ ), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2° in flexion ($$C{I}_{95\%}=\left[0.4^\circ ,11.9^\circ \right]$$ C I 95 % = 0 . 4 ∘ , 11 . 9 ∘ ) and by 5.8° in abduction ($$C{I}_{95\%}=\left[3.0^\circ ,8.5^\circ \right]$$ C I 95 % = 3 . 0 ∘ , 8 . 5 ∘ ). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task. Conclusion These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios. Trial Registration ClincalTrials.gov (ID NCT04154098). Registered: November 6th 2019, https://clinicaltrials.gov/ct2/show/NCT04154098?term=scapula+orthosis&draw=2&rank=1 Graphic abstract

Prevalence of Scapular Dyskinesis in Breastfeeding Postnatal Women in Satara District - An Observational Study

BACKGROUND Poor posture like hunching forward is one of the most commonly practiced postures by women during breastfeeding. The maintenance of such postures for prolonged period can result in progressive weakness of the scapular muscles and subsequent increase in the kyphotic curve. Both lordosis and kyphosis increase during pregnancy and are observed to be maintained for up to 2 months postnatally. The thoracic spine position and slouched position significantly affects the scapular dynamics during scapular abduction resulting in decreased muscle forces. Thus, scapular dyskinesis, defined as an alteration of normal position or motion of the scapula during coupled scapulohumeral movements can occur as a result of decreased muscle forces. Thus, this gives rise to the need for evaluating scapular dyskinesis and its prevalence in postnatal women. The purpose of the study was to find the prevalence of scapular dyskinesis in breastfeeding postnatal women. METHODS An observational analytical study was undertaken at Krishna Institute of Medical Sciences, including a total of 40 subjects within the age group of (15 - 40) yrs. who had been breastfeeding for 6 months or more. These subjects were assessed for scapular dyskinesis using Yes / No test and the lateral scapular slide test (LSST). Kyphosis was assessed on observational basis through postural assessment in these individuals. Statistical analysis was done using the InStat app. RESULTS 67 % and 75 % of the subjects were found to be positive for scapular dyskinesis through Yes / No Test and LSST test respectively. Observational assessment showed that 55 % of the subjects were positive for kyphosis. Subjects demonstrated significant prevalence of scapular dyskinesis and subsequent kyphosis in postnatal females due to wrong ergonomic practice of breastfeeding. CONCLUSIONS The study shows that women lack proper knowledge about the breastfeeding ergonomics leading to weakness of scapular muscles. Thus, a significant prevalence of scapular dyskinesis was seen in breastfeeding postnatal women. KEY WORDS Breastfeeding, Scapular Muscle Weakness, Kyphosis, Ergonomics, Scapular Dyskinesis