Context: Shoulder injuries are common in athletes involved in overhead sports, and scapular dyskinesis is believed to be one causative factor in these injuries. Many authors assert that abnormal scapular motion, so-called dyskinesis, is related to shoulder injury, but evidence from 3-dimensional measurement studies regarding this relationship is mixed. Reliable and valid clinical methods for detecting scapular dyskinesis are lacking.Objective: To determine the interrater reliability of a new test designed to detect abnormal scapular motion.Design: Correlation design using ratings from multiple pairs of testers.Setting: University athletic training facilities. Videotapes from randomly chosen participants were subsequently viewed and independently rated for the presence of scapular dyskinesis by 6 raters (3 pairs), with each pair rating 30 different participants. Raters were trained to detect scapular dyskinesis using a self-instructional format with standardized operational definitions and videotaped examples of normal and abnormal motion.Main Outcome Measure(s): Scapular dyskinesis was defined as the presence of either winging or dysrhythmia. Right and left sides were rated independently as normal, subtle, or obvious dyskinesis. We calculated percentage of agreement and weighted kappa (k w ) coefficients to determine reliability.Results: Percentage of agreement was between 75% and 82%, and k w ranged from 0.48 to 0.61.Conclusions: The test for scapular dyskinesis showed satisfactory reliability for clinical use in a sample of overhead athletes known to be at increased risk for shoulder symptoms.Key Words: shoulder, upper extremity, kinematics, assessment Key Points N Trained athletic trainers and physical therapists can recognize and distinguish between abnormal scapular movement patterns and normal patterns in young, athletically active adults.N The scapular dyskinesis test provides a reliable method for clinical examination of overhead athletes.

Context:The prevalence of shoulder pain among competitive swimmers is high, but no guidelines exist to reduce shoulder injuries. Elucidating differences between swimmers with and without shoulder pain can serve as a basis for the development of a program to prevent shoulder injury that might lead to pain and dysfunction.Objective: To determine whether physical characteristics, exposure, or training variables differ between swimmers with and without shoulder pain or disability.Design: Cross-sectional study. Setting: Multisite swimming centers. Patients or Other Participants:A total of 236 competitive female swimmers aged 8 to 77 years.Data Collection and Analysis: Participants completed the Penn Shoulder Score and underwent testing of core endurance, range of motion, muscle force production, and pectoralis minor muscle length and the Scapular Dyskinesis Test. Swimmers were grouped by age for analysis: ages 8 to 11 years (n = 42), 12 to 14 years (n = 43), 15 to 19 years (high school, n = 84), and 23 to 77 years (masters, n = 67). Comparisons were made between groups with and without pain and disability using independent t tests for continuous data and χ 2 analyses and Fisher exact tests for categorical data.Results: Nine (21.4%) swimmers aged 8 to 11 years, 8 (18.6%) swimmers aged 12 to 14 years, 19 (22.6%) high school swimmers, and 13 (19.4%) masters swimmers had shoulder pain and disability. Differences that were found in 2 or more age groups between athletes with and without shoulder pain and disability included greater swimming exposure, a higher incidence of previous traumatic injury and patient-rated shoulder instability, and reduced participation in another sport in the symptomatic groups (P < .05). Reduced shoulder flexion motion, weakness of the middle trapezius and internal rotation, shorter pectoralis minor and latissimus, participation in water polo, and decreased core endurance were found in symptomatic females in single varying age groups (P < .05).Conclusions: Female competitive swimmers have shoulder pain and disability throughout their lives. Given that exposure and physical examination findings varied between athletes with and without substantial pain and disability, a program to prevent shoulder injury that might lead to pain and dysfunction appears warranted and might include exposure reduction, cross-training, pectoral and posterior shoulder stretching, strengthening, and core endurance training.Key Words: swimming, exposure variables, injury prevention Key Points• Competitive swimmers less than 12 years of age had substantial shoulder pain, and older swimmers had pain, dissatisfaction, and disability.• High school swimmers were the most symptomatic and incurred the greatest load in terms of hours swum per week and per year.• Shoulder pain, dissatisfaction, and disability were correlated positively with increased upper extremity usage in terms of swimming or water polo exposure and were correlated negatively with participation in another sport, specifically soccer for young and running or walk...

Context: Although clinical methods for detecting scapular dyskinesis have been described, evidence supporting the validity of these methods is lacking.Objective: To determine the validity of the scapular dyskinesis test, a visually based method of identifying abnormal scapular motion. A secondary purpose was to explore the relationship between scapular dyskinesis and shoulder symptoms.Design: Validation study comparing 3-dimensional measures of scapular motion among participants clinically judged as having either normal motion or scapular dyskinesis.Setting: University athletic training facilities. Patients or Other Participants: A sample of 142 collegiate athletes (National Collegiate Athletic Association Division I and Division III) participating in sports requiring overhead use of the arm was rated, and 66 of these underwent 3-dimensional testing.Intervention(s): Volunteers were viewed by 2 raters while performing weighted shoulder flexion and abduction. The right and left sides were rated independently as normal, subtle dyskinesis, or obvious dyskinesis using the scapular dyskinesis test. Symptoms were assessed using the Penn Shoulder Score.Main Outcome Measure(s): Athletes judged as having either normal motion or obvious dyskinesis underwent 3-dimensional electromagnetic kinematic testing while performing the same movements. The kinematic data from both groups were compared via multifactor analysis of variance with post hoc testing using the least significant difference procedure. The relationship between symptoms and scapular dyskinesis was evaluated by odds ratios.Results: Differences were found between the normal and obvious dyskinesis groups. Participants with obvious dyskinesis showed less scapular upward rotation (P , .001), less clavicular elevation (P , .001), and greater clavicular protraction (P 5 .044). The presence of shoulder symptoms was not different between the normal and obvious dyskinesis volunteers (odds ratio 5 0.79, 95% confidence interval 5 0.33, 1.89).Conclusions: Shoulders visually judged as having dyskinesis showed distinct alterations in 3-dimensional scapular motion. However, the presence of scapular dyskinesis was not related to shoulder symptoms in athletes engaged in overhead sports.

[ research report ] t Study deSign: Two-group, repeatedmeasures design.t ObjectiveS: To determine whether manually repositioning the scapula using the Scapula Reposition Test (SRT) reduces pain and increases shoulder elevation strength in athletes with and without positive signs of shoulder impingement.t backgrOund: Symptom alteration tests may be useful in determining a subset of those with shoulder pathology who may benefit from interventions aimed at improving scapular motion abnormalities.t MethOdS and MeaSureS: One hundred forty-two college athletes underwent testing for clinical signs of shoulder impingement. Tests provoking symptoms were repeated with the scapula manually repositioned into greater retraction and posterior tilt. A numeric rating scale was used to measure symptom intensity under both conditions. Isometric shoulder elevation strength was measured using a mounted dynamometer with the scapula in its natural position and with manual repositioning. A paired t test was used to compare the strength between positions. The frequency of a significant increase in strength with scapular repositioning, defined as the minimal detectable change (90% confidence interval), was also assessed.t reSultS: Of the 98 athletes with a positive impingement test, 46 had reduced pain with scapular repositioning. Although repositioning produced an increase in strength in both the impingement (P = .001) and nonimpingement groups (P = .012), a significant increase in strength was found with repositioning in only 26% of athletes with, and 29% of athletes without, positive signs for shoulder impingement. 27,51 In addition to the variability of findings in these studies, the magnitude of differences between those with healthy shoulders and those with pathology is typically small (in the 3° to 5° range), and it is unclear whether these differences, although statistically significant, are really of clinical significance. Because of the variability of findings in symptomatic subjects and the generally small kinematic differences found compared to asymptomatic subjects, correctly identifying patients with relevant scapular dysfunction is difficult.An alternative approach in attempting to identify those with scapular motion abnormalities is the use of symptom altering tests. The premise of these tests is to assess the magnitude of symptoms during provocation tests or shoulder movements when the scapula is in its natural position and then to repeat the provocative tests and shoulder movements with the examiner manually altering scapular motion or position. Two symptom alteration tests have been reported in the literature. The Modified Scapular Assistance test involves application of both an upward rotary and retraction force to the scapula by a single examiner in an effort to reduce pain during arm elevation. Rabin et al 40 reported satisfactory interrater reliability of this test for clinical use. The Scapula Retraction Test has been described as 1 Physical Therapist, H/S Therapy Associates, Inc, Lower Gwynedd, PA; Associate Fac...