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.

The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 1

“…The effect of manual correction involves therapist assistance of the scapula and/or HH when the patient performs an objective test to determine whether the assisted position improves the result of that test. 21,[26][27][28][29][30][31] Poor scapula positioning through range and altered muscle patterning are predominant characteristics of nontraumatic MDI 32,33 and so an immediate improvement with manual assistance is likely to confirm the presence of these characteristics and indicate that the patient is appropriate for treatment with exercise. 31 Although the reliability and validity of some shoulder corrective techniques have been established, 34,35 to date, research on the reliability and validity and on establishing normative values for shoulder corrective tests in MDI is incomplete.…”

“…Humeral head correction is performed by applying a gentle anterior to posterior or posterior to anterior 34,35 pressure to the HH. 21,31,36 For assessing the correction of anterior translation, the assessment of active ER in varying degrees of abduction 3,36 or isometric ER is commonly employed (Figure 1b). For assessing the correction of posterior translation, flexion 3 or horizontal flexion range of motion is commonly employed (Figure 1c).…”

Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes

“…Several factors make SD challenging in the clinical context, such as high variability of scapular movement, possibility of adaptive strategies, difficulty of a “normal” pattern definition, poor methodological quality regarding properties, and lack of clarity in the relationship between SD and presence of symptoms [ 9 , 21 ]. Based on the findings of the present study, we recommend to add at least eight repetitions of shoulder movements with external load based on body mass (1.5 kg or 2.5 kg) and an SD evaluation training (SD description study, photographs and videos analyzed, and pilot assessment) of physical therapists that do not need to be an expert in the field.…”

“…Adding load to the movement seems to improve the reliability of SD classification depending on the evaluation method. More information is required regarding adding load to the movement and also further research into new approaches to scapular evaluation based on whole system and context instead of the scapula alone [ 21 ].…”

Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review

“…14 Based on this widely held view, the aim of many shoulder rehabilitation programs is to correct aberrant local scapular mechanics. 15 Clinicians often manage SIS with various treatment techniques to address the strength deficits and altered pattern of scapular kinematics that lead to injury and are modifiable characteristics to improve patient outcomes, such as reducing pain and decreasing shoulder dysfunction. These techniques include, but are not limited to, posterior shoulder stretching for capsular abnormalities 16,17 ; scapular bracing to correct poor posture 18 ; taping that was claimed to correct aberrant kinematic patterns due to poor rotator cuff or scapular muscle function [19][20][21] ; thoracic spine manipulation to readjust the alignment of thoracic vertebrae where important scapular muscles are attached, modify costovertebral mobility, or possibly enhance neuromuscular control of scapulothoracic muscles [22][23][24][25] ; rotator cuff and other scapular muscle strengthening 8,16,[26][27][28][29] to stabilize or position the scapula properly 30 during dynamic shoulder movement; neuromuscular reeducation for coordinated activation of scapular muscles during shoulder movement 27,29 ; and manual therapy, such as joint mobilization to restore proper joint mobility.…”