Current concepts: scapular dyskinesis

Abstract

The scapula serves many roles in order for proper shoulder function to occur. These roles include providing synchronous scapular rotation during humeral motion, serving as a stable base for rotator cuff activation and functioning as a link in the kinetic chain. Each role is vital to proper arm function and can only occur when the anatomy around the shoulder is uncompromised. The presence of bony and soft tissue injury as well as muscle weakness and inflexibility can alter the roles of the scapula and alter scapular resting position and/or dynamic motion. This altered scapular position/movement has been termed 'scapular dyskinesis'. Although it occurs in a large number of shoulder injuries, it appears that scapular dyskinesis is a non-specific response to a painful condition in the shoulder rather than a specific response to certain glenohumeral pathology. The presence or absence of scapular dyskinesis needs to be determined during the clinical examination. An examination consisting of visual inspection of the scapular position at rest and during dynamic humeral movements, along with the performance of objective posture measurements and scapular corrective maneuvers, will help the clinician ascertain the extent to which the scapula is involved in the shoulder injury. Treatment of scapular dyskinesis should begin with optimised anatomy and then progress to the restoration of dynamic scapular stability by strengthening of the scapular stabilisers utilising kinetic chain-based rehabilitation protocols.