Scapular dyskinesia: evolution towards a systems-based approach

Abstract

Historically, scapular dyskinesia has been used to describe an isolated clinical entity whereby an abnormality in positioning, movement or function of the scapula is present. Based upon this, treatment approaches have focused on addressing local isolated muscle activity. Recently, however, there has been a progressive move towards viewing the scapula as being part of a wider system of movement that is regulated and controlled by multiple factors, including the wider kinetic chain and individual patient-centred requirements. We therefore propose a paradigm shift whereby scapular dyskinesia is seen not in isolation but is considered within the broader context of patient-centred care and an entire neuromuscular system.

Keywords: assessment; dyskinesis; rehabilitation; scapula; shoulder.

Figure 1.

Potential symptom modification procedures.

Figure 2.

Assessment findings and treatment planning.

Figure 3.

Through range assessment of the rotator cuff. The scapula is stabilized and therefore not working in its dynamic role.

Figure 4.

Assessment reasoning.

Figure 5.

The dyskinesis of this breakdancer disappears with closed chain loading.

Figure 6.

Potential early exercises dependent on response to symptom modification.

Figure 7.

Scapular dyskinesis: traditional model versus a symptoms and systems-based approach.