Current Views of Scapular Dyskinesis and its Possible Clinical Relevance

Abstract

Scapular dyskinesis is a condition that is frequently observed clinically but not often understood. Too often it is viewed as a diagnosis which is not accurate because it is a physical impairment. This misclassification of dyskinesis has resulted in literature that simultaneously supports and refutes scapular dyskinesis as a relevant clinical entity as it relates to arm function. These conflicting views have not provided clear recommendations for optimal evaluation and treatment methods. The authors' experience and scholarship related to scapular function and dysfunction support that scapular dyskinesis is an impairment that has causative factors, that a pathoanatomical approach should not be the primary focus but should be considered as part of a comprehensive examination, that a qualitative examination for determining the presence or absence of a scapular contribution to shoulder dysfunction is currently the best option widely available to clinicians, and that rehabilitation approaches should be reconsidered where enhancing motor control becomes the primary focus rather than increasing strength.

Keywords: scapular dyskinesis; shoulder; shoulder rehab.

Figure 1.. Scapular Contribution Algorithm

Figure 2.. Evaluation Approach

Figure 3.. Scapular Dyskinesis Test. The patient elevates the arms overhead 3-5 times while the examiner visually observes the scapular movement.

Figure 4.. Scapular Assistance Test. The scapula is stabilized with one hand and the other hand ‘assists’ the scapula through its correct motion plane.

Figure 5.. Scapular Retraction Test. The examiner first performs a traditional flexion manual strength test (a). The examiner stabilizes the medial border of the scapula and repeats the test (b).

Figure 6.. Low Row Test. The examiner manually resists arm extension without followed by with gluteal muscle activation.

Figure 7.. Conscious correction of scapula begins with the patient standing (a) and being instructed to actively “squeeze your shoulder blades together” (b). Utilization of mirrors or mobile devices can assist patients with visualizing correct scapular positioning.

Figure 8.. The Low Row begins in the starting position of standing and knees slightly bent (a). The patient performs extension of the hips and trunk to facilitate scapular retraction (b).

Figure 9.. Lawnmower with arm close to body begins with the patient standing and the arm close to the body as if supported by a sling (a). The patient is instructed to extend the hips and trunk followed by rotation of the trunk to facilitate scapular medial translation and retraction (b).

Figure 10.. The Robbery maneuver requires instructions to the patient to “place the elbows in the back pockets” moving from a trunk and hip slightly flexed position (a) and moving to an extended position (b).

Figure 11.. Lawnmower with arm away from body is the advancement of the previous lawnmower exercise with the arm in a slightly flexed position to begin (a) but the same hip extension and trunk rotation components (b).

Figure 12.. The Fencing exercise begins with the arm elevated to 90° in the frontal plane (a) and performed by side stepping and simultaneously retracting the scapula and adducting the arm (b).