Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate

Abstract

The improper movement of the scapula during shoulder movement is termed scapular dyskinesis and is an often-forgotten cause of pain and dysfunction. The scapula is a key part of the upper limb kinematic chain and is a vital component of the glenohumeral rhythm; which is a major determinant of the efficiency and efficacy of the upper limb. We provide an overview of the complex regional anatomy of the shoulder girdle and how this allows the scapula to act as a both a dynamic and static stabilizer to the upper limb. We explore the normal biomechanics and the aetiology, epidemiology and pathological occurrences which can disrupt the normal function and lead to scapula dyskinesis. Scapula dyskinesis is a poorly understood condition and provides a challenge for the clinician in both diagnosis and management. We provide a summary of the clinical assessment which is most likely to identify the source of the pathology and guides the treatment which is largely rehabilitation of the musculature with focused and specialized physiotherapy.

Figure 1

The scapular movement in relation to humeral abduction and the corresponding muscle vectors that affect it.

Figure 2

The scapular assistance test (SAT), a manually assisted examination manoeuvre.

Figure 3

The scapular reposition (retraction) test (SRT) a manually assisted examination manoeuvre.

Figure 4

The “cross body stretch”, a useful technique to relax the posterior capsule of the glenohumeral joint.

Figure 5

An example of open chain exercise that promotes engagement of the rhomboid and the supraspinatus.