Kibler and McMullen reviewed how altered scapular position and motion arises with shoulder injury, how it adds to shoulder dysfunction, and how it can be examined, classified and treated.
Methods
Scope
The scapula's role in shoulder function and in dysfunction after injury
Topics
Normal scapular function
Causes of dyskinesis
Classification
Physical examination
Kinetic chain‑based rehabilitation
Key Points
Dyskinesis appears to be a nonspecific reaction to shoulder dysfunction, since no single pattern matches a particular diagnosis.
It most often follows injuries that inhibit or disorganize how the scapular stabilizers are activated.
Nerve injury accounts for about 5% of cases: long thoracic injury affecting the serratus anterior or spinal accessory injury affecting the trapezius.
Cited studies found dyskinesis in up to 68% of rotator cuff abnormalities, 94% of labral tears and 100% of glenohumeral instability cases.
On the isometric retraction endurance test, burning pain in under 15 seconds may indicate scapular muscle weakness, whereas a normal scapula holds the position for 15 to 20 seconds.
Board pearl
On the lateral scapular slide test, a side‑to‑side asymmetry of 1.5 cm marks abnormality, seen most often in position 3, and the test is more sensitive for types I and II.
Types of scapular dyskinesisKibler, J Am Acad Orthop Surg 2003
Type I
Inferior medial border prominent
Abnormal rotation mainly about a transverse axis
Type II
Whole medial border prominent
Abnormal rotation about a vertical axis
Type III
Whole scapula translated superiorly, with the superior medial border prominent
Authors' conclusion
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.
Kibler and McMullen reviewed how altered scapular position and motion arises with shoulder injury, how it adds to shoulder dysfunction, and how it can be examined, classified and treated.
Methods
Scope
The scapula's role in shoulder function and in dysfunction after injury
Topics
Normal scapular function
Causes of dyskinesis
Classification
Physical examination
Kinetic chain‑based rehabilitation
Key Points
Dyskinesis appears to be a nonspecific reaction to shoulder dysfunction, since no single pattern matches a particular diagnosis.
It most often follows injuries that inhibit or disorganize how the scapular stabilizers are activated.
Nerve injury accounts for about 5% of cases: long thoracic injury affecting the serratus anterior or spinal accessory injury affecting the trapezius.
Cited studies found dyskinesis in up to 68% of rotator cuff abnormalities, 94% of labral tears and 100% of glenohumeral instability cases.
On the isometric retraction endurance test, burning pain in under 15 seconds may indicate scapular muscle weakness, whereas a normal scapula holds the position for 15 to 20 seconds.
Board pearl
On the lateral scapular slide test, a side‑to‑side asymmetry of 1.5 cm marks abnormality, seen most often in position 3, and the test is more sensitive for types I and II.
Types of scapular dyskinesisKibler, J Am Acad Orthop Surg 2003
Type I
Inferior medial border prominent
Abnormal rotation mainly about a transverse axis
Type II
Whole medial border prominent
Abnormal rotation about a vertical axis
Type III
Whole scapula translated superiorly, with the superior medial border prominent
Authors' conclusion
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.