SCAPULAR DYSKINESIS                                  KANDILNOTES

INTRODUCTION

  • Scapular dyskinesis is a common shoulder pathology characterized by abnormal shoulder blade (scapular) mechanics

  • Shoulder blade motion is very complex and an injury to one or more muscles in that chain can lead to scapular dyskinesis

  • This pathology is commonly seen in overhead and throwing athletes but can be present in the general public as well

  • Scapular dyskinesis can lead to the structures between the proximal humerus and acromion (subacromial bursa and rotator cuff tendon) getting pinched, causing inflammation and rotator cuff tendinitis. Both of these processes are very painful and are worse with overhead activities

  • Scapular dyskinesis can lead to the following

  • Shoulder impingement

  • Subacromial bursitis

  • Shoulder labrum injury

 

CAUSES

  • Scapular dyskinesis has numerous causes

  • Neurologic injury

  • Abnormal throwing mechanics

  • Muscular deconditioning

  • Repetitive overhead activities can predispose to shoulder impingement, subacromial bursitis, and rotator cuff tendinitis

  • Weak or deconditioned shoulder blade muscles lead to abnormal scapular and shoulder mechanics, causing the shoulder to rub against the acromion and apply extra pressure on structures such as the rotator cuff and the labrum

 

SIGNS AND SYMPTOMS

  • Patients with scapular dyskinesis have shoulder blade crunching (crepitus), winging, and pain that is worse with overhead activities

  • Patient with scapular dyskinesis often have pain with throwing or overhead activities

TREATMENT​​

  • A course of physical therapy or a home exercise program is the mainstay of treatment for shoulder scapular dyskinesis. The idea is that strengthening the shoulder blade muscles will correct scapular mechanics thereby decreasing the likelihood of the shoulder rubbing against the acromion and injuring structures such as the labrum and rotator cuff. Goals of Scapular Dyskinesis PT include

  • Core strengthening 

  • Shoulder blade strengthening including serratus anterior and trapezius

  • Rotator cuff stabilization

  • Anti-inflammatories such as ibuprofen or meloxicam may help decrease inflammation 

  • A corticosteroid injection can locally decrease the inflammation and pain

PREVENTION

  • Keeping the shoulder blade stable by maintaining strong scapular muscles is the best way to prevent scapular dyskinesis

  • Proper throwing mechanics can also decrease the risk of injury due to scapular dyskinesis

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