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Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

Fizioterapija Veselības aprūpe Physiotherapy Health Care Bakalaura darba nosaukums: Lāpstiņas diskinēzijas sastopamība augstāko līgu basketbola spēlētājām/-iem Aktualitāte: Pētījumi liecina, ka sportistiem, kuri veic regulāras kustības ar rokām virs galvas līmeņa lāpstiņas diskinēzija ir plaši sastopama, salīdzinot ar sporta veidiem, kuros lielas amplitūdas roku kustības bieži netiek veiktas, rādītāji ir nozīmīgi augstāki. Pastāv pētījumi, kuros konstatēta lāpstiņas diskinēzijas saistība ar plecu joslas sāpēm un traumu risku, tomēr šī mijiedarbība nav pārliecinoši skaidra. Pētījuma mērķis: Noskaidrot lāpstiņas diskinēzijas sastopamību Latvijas augstāko basketbola līgu spēlētāju vidū. Pētījuma metodes: Pētījumā piedalījās 37 personas - basketbolisti, no tiem 23 sievietes un 14 vīrieši no trim Latvijas augstāko līgu komandām (divas sieviešu, viena vīriešu komanda). Dalībniekiem tika lūgts sniegt antropometriskos datus un informāciju par basketbola pieredzi, sāpju, traumu anamnēzi. Tika novērtēta lāpstiņas statiskā stabilitāte, nosakot lāpstiņas spārnveida pozīcijas esamību, augšējo un apakšējo horizotālo distanci- attālums no lāpstiņas stūra līdz tuvākajam proc. spinosus. Tika novērtēta arī statiski - dinamiskā stabilitāte un dinamiskā stabilitāte, attiecīgi, izmantojot apakšējas horizontālās distances noteikšanu, rokām atrodoties maksimālas fleksijas pozīcijā, un Lāpstiņas diskinēzijas testu. Kā arī noteica plecu protrakcijas lielumu atbrīvotā pozīcijā un, veicot retrakciju. Pētījuma rezultāti: Pētījuma grupai lāpstiņas diskinēzijas sastopamība bija zemāka nekā citos pētījumos konstatēts. Statistiski nozīmīga bija atšķirība labās lāpstiņas diskinēzijas sastopamībā starp pētījuma dalībniekiem, atkarībā no faktora, vai iesildoties veic vingrinājumus plecu joslai, lāpstiņām. Lāpstiņas diskinēzijas sastopamība neatškīrās statistiski nozīmīgi starp dominanto un nedominanto pusi, kā arī pieredze basketbolā, treniņu biežums, plecu joslas sāpes un traumas anamnēzē neradījā nozīmīgas atšķirības rezultātos. Plecu protrakcijas un statiskās stabilitātes mērījumu rādītāji neatšķīrās atkarībā no tā, vai personai bija lāpstiņas diskinēzija. Secinājumi: Lāpstiņas diskinēzijas sastopamība pētījuma grupā bija augsta, taču zemāka kā citos pētījumos minētais lielums. Nekonstatēja nozīmīgas sakarības starp plecu protrakcijas lielumu un lāpstiņas diskinēzijas izplatību. Atslēgas vārdi: Lāpstiņa, lāpstiņas diskinēzija, angl. overhead athletes, lāpstiņas diskinēzijas novērtēšana, scapulohumerālais ritms, protrakcija. ANOTATION Title: Incidence of scapular dyskinesis in major league basketball players. Topicality: Studies have shown that scapular dyskinesis is common in overhead athletes, compared to nonoverhead athletes, the rates are significantly higher. There are studies linking scapular dyskinesis to shoulder girdle pain and risk of injury, however this interaction is not conclusively clear. Aim of the study: To find out the incidence of scapular dyskinesis among basketball players of the highest leagues in Latvia. Methods: Research methods: The study observed 37 persons - basketball players, of which 23 were women and 14 were men from three teams of Latvia's top leagues (two women's, one men's team). Participants were asked to provide anthropometric data and information about basketball experience and pain, injury history. The static stability of the scapula, the existence of a winging position of the scapula, the upper and lower horizontal distance - the distance from the corner of the scapula to the nearest proc.spinosus. Semi-dynamic stability and dynamic stability were also evaluated, by using the determination of the lower horizontal distance with the arms in the position of maximal flexion and the Scapular dyskinesis test. Also determined amount of protraction of the shoulders in relaxed position and during retraction. Results of the study: In the study group, the incidence of scapular dyskinesis was lower than found in other studies. There was a statistically significant difference in the incidence of right scapular dyskinesis among the study participants, depending on the factor of warm-up exercises for shoulders and scapulae. The incidence of scapular dyskinesis was not statistically significantly different between the dominant and non-dominant side, and basketball experience, training frequency, shoulder pain, and history of injury did not make a significant difference in the results. Results on measures of shoulder protraction and static stability did not differ depending on whether a person had scapular dyskinesis. Conclusion: The incidence of scapular dyskinesis in the study group was high, but lower than reported in other studies. No sugnificant correlation was found between the values of shoulder protraction and the prevalence of scapular dyskinesis. Keywords: Scapula, scapular dyskinesis, overhead athletes, measurement of scapular dyskinesis, scapulohumeral rhythm, protraction.

Scapular dyskinesis can be present in healthy individuals as in patients with shoulder pathology. Altered patterns of scapular kinematics can cause or exacerbate rotator cuff tear pathology. However, more research is needed. Regardless of the cause or the consequence of rotator cuff tear, scapular dyskinesis impairs shoulder function, worsens the symptoms, and compromises the success of clinical intervention. The available literature suggests physical therapy as the first treatment for degenerative cuff tears, and scapular dyskinesis should be addressed if present. Non-responsive cases or traumatic tears may require surgery. Postsurgical physical therapy protocols after rotator cuff repair must consider scapular dyskinesia to improve the outcomes. Cite this article: EFORT Open Rev 2021;6:932-940. DOI: 10.1302/2058-5241.6.210043

BACKGROUND Poor posture like hunching forward is one of the most commonly practiced postures by women during breastfeeding. The maintenance of such postures for prolonged period can result in progressive weakness of the scapular muscles and subsequent increase in the kyphotic curve. Both lordosis and kyphosis increase during pregnancy and are observed to be maintained for up to 2 months postnatally. The thoracic spine position and slouched position significantly affects the scapular dynamics during scapular abduction resulting in decreased muscle forces. Thus, scapular dyskinesis, defined as an alteration of normal position or motion of the scapula during coupled scapulohumeral movements can occur as a result of decreased muscle forces. Thus, this gives rise to the need for evaluating scapular dyskinesis and its prevalence in postnatal women. The purpose of the study was to find the prevalence of scapular dyskinesis in breastfeeding postnatal women. METHODS An observational analytical study was undertaken at Krishna Institute of Medical Sciences, including a total of 40 subjects within the age group of (15 - 40) yrs. who had been breastfeeding for 6 months or more. These subjects were assessed for scapular dyskinesis using Yes / No test and the lateral scapular slide test (LSST). Kyphosis was assessed on observational basis through postural assessment in these individuals. Statistical analysis was done using the InStat app. RESULTS 67 % and 75 % of the subjects were found to be positive for scapular dyskinesis through Yes / No Test and LSST test respectively. Observational assessment showed that 55 % of the subjects were positive for kyphosis. Subjects demonstrated significant prevalence of scapular dyskinesis and subsequent kyphosis in postnatal females due to wrong ergonomic practice of breastfeeding. CONCLUSIONS The study shows that women lack proper knowledge about the breastfeeding ergonomics leading to weakness of scapular muscles. Thus, a significant prevalence of scapular dyskinesis was seen in breastfeeding postnatal women. KEY WORDS Breastfeeding, Scapular Muscle Weakness, Kyphosis, Ergonomics, Scapular Dyskinesis

Context: Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. Objective: To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. Method: This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11) m, and weight 60.90 (10.36) kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. Results: A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P 1) was observed across most of the variables. Conclusion: An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility.

Összefoglaló. Bevezetés: A megváltozott statikus és/vagy dinamikus lapockapozíciót, azaz a scapuladyskinesist gyakran vonják párhuzamba a vállelváltozásokkal. Mindemellett a lapocka kinematikai eltérései nagy számban jelen lehetnek tünetmentes egyéneknél is, melegágyat biztosítva a későbbi vállelváltozások kialakulásának. Célkitűzés: Munkánk fő célja az volt, hogy felhívja a figyelmet ezen problémakör fontosságára, valamint hogy megvizsgálja a scapuladyskinesis előfordulásának gyakoriságát és körülményeit az átlagpopulációban. Módszer: Mintánk 70 főből állt (átlagéletkor: 22,17 ± 1,77 év). 67%-uk férfi, míg 33%-uk nő volt. A scapuladyskinesis fennállását McClure-féle ’Scapular Dyskinesis Test’-tel vizsgáltuk. A résztvevők vállfájdalmának intenzitását vizuális analóg skála segítségével, habituális testtartásukat fotogrammetriás módszerrel, főbb lapockastabilizáló izmaik izomerejét pedig Kendall-féle manuális izomerőtesztekkel mértük fel. Mindemellett felvettük antropometriai adataikat, valamint megkérdeztük, hogy milyen gyakran végeznek sporttevékenységet. Eredmények: A résztvevők 53%-ánál találtunk valamilyen fokú scapuladyskinesist. A habituális testtartást vizsgáló fotogrammetriás felmérés eredményei és a scapuladyskinesist mérő McClure-féle teszt eredményei között szignifikáns összefüggést találtunk (p = 0,01). A sportolási gyakoriság és a scapuladyskinesis előfordulása között jelentős összefüggést tapasztaltunk (p = 0,01). A fájdalom erőssége és a scapuladyskinesis előfordulása között szignifikáns volt az összefüggés (p = 0,03). A scapuladyskinesist mérő McClure-féle teszt és az azonos oldali felső végtagon izomerő-csökkenést mutató tesztek eredményei között szintén szignifikáns összefüggést tapasztaltunk (p = 0,01). Következtetés: Az elit sportolók mellett az átlagos populációban is jelentős mértékben jelen lehetnek a lapocka kinematikai eltérései. Mindez jelentős összefüggésben állhat az adott személy életmódjával és egészségmagatartásával, valamint kiemelt szerepet játszhat a krónikus vállfájdalom kialakulásában. Orv Hetil. 2021; 162(15): 587–594. Summary. Introduction: The altered static and/or dynamic scapular position, i. e., scapular dyskinesis, is often paralleled with shoulder pathologies. However, shoulder kinematic abnormalities may also be present in large numbers in asymptomatic individuals. Objective: The main goal of our work was to draw attention to the importance of scapular dyskinesis in shoulder pathologies. Method: The final sample consisted of 70 people (average age: 22.17 ± 1.77 years), 67% of them was male and 33% female. The presence of scapular dyskinesis was assessed by McClure’s Scapular Dyskinesis Test. Visual analog scale was used to examine the shoulder pain of the participants, photogrammetric method was used to document their habitual posture. Kendall’s manual muscle testing methods were used to determine the muscle strength of the individual muscles of the shoulder girdle; we also recorded their anthropometric data and asked them about their sporting habits. Results: In 53% of the participants, some degree of scapular dyskinesis was found. We observed significant correlation between the sporting habits and scapular dyskinesis (p = 0.01). Significant correlation was observed between the posture and scapular dyskinesis (p = 0.01). Between the strength of pain and the dyskinesis, we found a significant correlation (p = 0.03). There was a significant correlation between the results of the McClure’s test and the tests showing muscle strength loss around the scapula (p = 0.01). Conclusion: In addition to elite athletes, scapular dyskinesis may also be significantly present in the average population and can play a key role in the development of shoulder pain. Orv Hetil. 2021; 162(15): 587–594.

Spine posture, mobility and strength can be associated with changes in scapular movement and shoulder pain. However, these aspects have not been assessed in healthy individuals with scapular dyskinesis without shoulder and/or back pain. Objective: To analyze spine posture, mobility and strength in healthy individuals with and without scapular dyskinesis. Method: Cross-sectional study, fifty-two college-aged individuals were divided into two groups, according to scapular dyskinesis testing: a group without scapular dyskinesis (n= 19; age= 22.95±2.86 years; BMI= 22.97±3.12 kg/m²; 10 males) and another with scapular dyskinesis (n= 33; age= 22.06±2.73 years; BMI= 22.14±3.22 kg/m²; 10 males). Posture of the head and shoulders was analyzed from photographs by a postural assessment software (PAS/SAPO). Thoracic kyphosis and range of motion of the cervical and thoracolumbar spine were measured by a digital inclinometer, and the strength of the cervical and thoracolumbar spine muscles by a hand-held dynamometer. Intergroup comparison for all the variables was conducted using analysis of variance (one-way ANOVA), considering p≤0.05 as significant. Results: No intergroup difference was found for spine posture (p= 0.18-0.99), mobility (p= 0.23-0.96) and strength (p= 0.42-0.99). Conclusion: Spine posture, mobility and strength do not differ between healthy individuals with and without scapular dyskinesis. The outcomes suggest that scapular dyskinesis may be related to interpersonal variations. Future prospective studies be conducted in order to verify if these variables can change and influence the development of shoulder pain.

Background: Scapular dyskinesis has been considered a risk factor for athletic shoulder injury; however, findings in the prospective literature have demonstrated mixed results. Purpose: To determine if scapular dyskinesis increases the risk of shoulder injury in athletes. Study Design: Meta-analysis. Methods: A systematic search was conducted on the MEDLINE, CINAHL Plus, SPORTDiscus, and Embase databases to identify prospective studies examining scapular dyskinesis and shoulder injury risk in athletes. Studies were included if they assessed participants using a dynamic scapular assessment at baseline and monitored for the development of shoulder injury. Data from the studies were subject to meta-analysis using the Mantel-Haenszel method to produce a pooled risk ratio. Results: Seven studies were eligible for inclusion, resulting in 212 shoulder injuries observed across 923 athletes. Scapular dyskinesis was present in 46% of participants, and these athletes had an injury rate of 25%. The presence of scapular dyskinesis displayed a trend to increase the risk of shoulder injury, but this was not statistically significant (risk ratio, 1.07; 95% CI, 0.85-1.34; P = .59). Conclusion: Scapular dyskinesis was not significantly associated with the development of shoulder injury in athletes. Registration: CRD42019133089 (PROSPERO).

Background Scapular dyskinesis (SD) has been associated with shoulder soft-tissue tightness as well scapular muscle strength and/or activation deficits. Inadequate development of the trapezius muscle (trapezius dysplasia) is a relatively rare condition inconsistently associated with shoulder dysfunction. Case description a 24-year old male complaining of left scapular area pain associated with SD and scapular muscle weakness was noted to present with a smaller ipsilateral lower trapezius (LT). Further inquiry including electromyography, rehabilitative ultrasound imaging (RUSI) and magnetic resonance imaging ruled out nerve palsy and demonstrated a hypoplastic left LT. This led to a greater emphasis on serratus anterior (SA) training along with the addition of neuromuscular electrical stimulation of the LT. Outcomes Following 12 sessions over a 5-month period the patient reported no pain or functional deficits, and was able to resume all recreational activities. The patient’s subjective shoulder value increased from 55% to 80%, and LT strength was markedly improved. Discussion Scapular muscle dysplasia may represent a less recognized cause of SD. A more thorough inspection of scapular muscle shape and orientation, possibly augmented by RUSI may be indicated in patients presenting with SD. Neuromuscular electrical stimulation is a potentially useful modality for addressing scapular muscle activation and strength deficits and future research into its efficacy under these circumstances may be warranted.

Background: Suspension training systems, which use body weight resistance under unstable conditions, may be effective for muscle strengthening in persons with scapular dyskinesis or subacromial impingement syndrome. Hypothesis: Greater arm, scapular, and trunk muscle recruitment will occur during horizontal abduction row exercises. Study Design: Descriptive laboratory study. Level of Evidence: Level 5. Methods: Surface electromyography data were collected from 28 participants (14 men, 14 women). A total of 13 right-sided muscles were studied at a sampling frequency of 1000 Hz. Maximal voluntary isometric contractions (MVICs) were established. Participants completed 3 repetitions per exercise in random order. We compared muscle recruitment during 3 rowing exercises: low row, high row, and horizontal abduction row. Data were compared with repeated-measures analyses of variance and post hoc Bonferroni corrections. Results: For high row and horizontal abduction row conditions, the upper, middle, and lower trapezius and posterior deltoid demonstrated >60% MVIC magnitudes of recruitment, and the upper erector spinae demonstrated 40% to 60% MVIC magnitudes of recruitment, respectively. In contrast, in the low row exercise, 40% to 60% MVIC magnitudes of recruitment were observed only in the middle trapezius, latissimus dorsi, and posterior deltoid. Conclusion: With the suspension system, high row and horizontal abduction row exercises promote muscle strengthening (>50% MVIC) in the upper, middle, and lower fibers of the trapezius, posterior deltoid, and upper erector spinae. Clinical Relevance: Rowing exercises performed with suspension straps may be recommended for muscle strengthening in patients with scapular dyskinesis and subacromial impingement syndrome as well as for healthy persons in need of enhanced scapular muscle performance.

The objective of this study was to assess the influence of scapular kinesiotaping and scapular muscle fatigue on tennis performance in dyskinetic players, with regard to racket velocity and the acc...

Background Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space. Objective The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities. Conclusions A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.

Background and purpose The return to play percentage of baseball pitchers who have undergone isolated superior labrum anterior-posterior (SLAP) repair has been reported to be less than 60%. Scapular dyskinesis (SD), characterized by scapular prominence during dynamic scapulohumeral movements, may be used to assist in diagnosing a baseball pitcher with shoulder pathology including a SLAP lesion. The purpose of this case report was to describe the use of the SD test to assess the scapular muscles and report EMG findings in a college baseball pitcher diagnosed with a Type 2 posterior SLAP lesion. Case description The subject was a NCAA-D1 senior collegiate baseball right hand 3/4 slot pitcher (21 years old) with a primary complaint of pain in the anterior portion of the shoulder during the entire fall practice season, which was attributed to labral surgery performed when he was a senior in high school. No positive clinical testing of the patient was found including: the sulcus sign, tests of gross instability, and the load & shift test. A Type II posterior SLAP lesion was identified via magnetic resonance imaging. The subject presented with glenohuemral internal rotation deficit (GIRD). The SD test identified moderate to severe prominence of scapular medial boarder in shoulder flexion/extension (FLX/EXT). Furthermore, surface EMG analyses indicated that the lower trapezius (LT) muscle was abruptly inhibited on the dominant side during the descending phase of FLX, compared with the non-dominant side. Additionally, a remarkably higher ratio of upper trapezius to LT muscle EMG activity on the dominant side compared to that of the non-dominant side was identified during the descending phase from flexion. Discussion After identification of SD, an off season conservative treatment program allowed him to compete in his last college baseball season, appearing 22 times out of the bullpen in which he was credited four wins with a 3.70 earned run average (ERA) in 41.1 innings in 57 games. The SD test may play a critical role in identifying rehabilitation potential and guide the focus of the rehabilitation program to improve scapulothoracic stability and mobility for unilateral repetitive overhead athletes. Particularly the descending phase during sagittal plane motion (FLX/EXT) may effectively accentuate the scapular prominence during movement, portentially due to LT muscle activity inhibition. Level of evidence 5 Case Report.

Context Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. Objective To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. Design Randomized controlled clinical trial. Setting Research laboratory. Patients or Other Participants Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). Main Outcome Measure(s) Three-dimensional kinematics and EMG were recorded before and after feedback training. Results Lower trapezius muscle activity increased (4.2%–18%, P < .011) and UT/LT decreased (0.56–1.17, P < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, P = .024). Conclusions The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. Trial Registration Number ClinicalTrials.gov: NCT03252444.

Pesquisa sem auxílio de agências de fomento Fundamentação teórica: A discinese escapular ocorre quando há uma ruptura perceptível da posição e dos movimentos da escápula e está diretamente relacionada com a função dos músculos periescapulares. É altamente prevalente em atletas overhead. entretanto, não está claro na literatura como é o comportamento muscular dos principais estabilizadores da escápula nessa população. Objetivo: Sumarizar os dados em relação à atividade eletromiográfica dos principais músculos estabilizadores da escápula em atletas overhead com discinese escapular (DE). Desenho de estudo: Revisão sistemática. Metodologia: As buscas eletrônicas foram realizadas nas bases de dados Pubmed (MedLine), Embase, CINAHL e SPORTDiscus. Estudos observacionais transversais foram incluídos se fossem conduzidos com atletas overhead e investigassem a atividade eletromiográfica dos trapézios superior (TS), médio (TM), e inferior (TI), e serrátil anterior (SA). Dois revisores independentes realizaram o screening, a extração de dados e a avaliação da qualidade metodológica dos estudos incluídos, que foi analisado por meio do ‘‘Checklist for Analytical Cross Sectional Studies’’, fornecidas pelo Instituto Joanna Briggs. Resultados: Foram encontrados 847 artigos, 623 referências foram avaliadas no screening e seis estudos foram incluídos nessa revisão. Evidências moderadas a altas sugeriram que os músculos TS, TM, TI, e SA possuem atividade EMG alterada em atletas overhead com DE durante uma variedade de tarefas descritas nos estudos incluídos. O TS teve sua atividade aumentada durante movimentos de extensão e rotação externa de ombro, em abdução no plano escapular e no plano frontal nos ângulos de 90° e 120°, e durante as fases de elevação e abaixamento da abdução e flexão sem carga. A atividade do TS foi associada ao padrão II de DE, considerando o abaixamento do membro no plano escapular. O TM mostrou maior atividade em extensão e rotação externa do ombro, e em abdução nos planos escapular e frontal nas angulações de 90° e 120°, além de sua atividade estar relacionada com o padrão II de DE. O TI apresentou maior atividade durante extensão e rotação externa do ombro. Houve também maior atividade do TI em abdução no plano escapular a 90° e 120°, sendo relacionada ao padrão I de DE. O SA mostrou maior atividade durante abdução nos planos escapular e frontal a 90° e 120°, bem como durante a fase de abaixamento da flexão e abdução com carga. Sua atividade foi relacionada com o padrão II de DE. Conclusão: Essa revisão revelou que o comportamento dos principais músculos estabilizadores da escápula tem alterações importantes em atletas overhead com DE, mas tem similaridades com as alterações observadas para indivíduos não overhead, sugerindo que a abordagem terapêutica seria similar para ambas as populações. Theoretical background: Scapular dyskinesis occurs when there is a noticeable disruption in the position and movement of the scapula and is directly related to the function of the periscapular muscles. It is highly prevalent in overhead athletes. however, it is not clear in the literature about the muscular behavior of the main scapula stabilizers in this population. Objective: To summarize the data regarding the electromyographic activity of the main stabilizing muscles of the scapula in overhead athletes with scapular dyskinesis (SD). Study design: Systematic review. Methodology: Electronic searches were performed in Pubmed (MedLine), Embase, CINAHL and SPORTDiscus databases. Cross-sectional observational studies were included if they were conducted with overhead athletes and investigated the electromyographic activity of the upper (TS), middle (TM), and lower (TI), and serratus anterior (SA) trapezius. Two independent reviewers performed the screening, data extraction and assessment of the methodological quality of the included studies, which was analyzed using the 'Checklist for Analytical Cross-Sectional Studies', provided by the Joanna Briggs Institute. Results: 847 articles were found; 623 references were evaluated and six studies were included in this review. Moderate to high evidence suggested that the TS, TM, TI, and SA muscles have altered EMG activity in overhead athletes with ED during a variety of tasks described in the included studies. The TS had its activity increased during shoulder extension and external rotation movements, in abduction in the scapular plane and in the frontal plane at angles of 90° and 120°, and during the lifting and lowering phases of abduction and flexion without load. The TS activity was associated with pattern II of DE, considering the lowering of the limb in the scapular plane. The TM showed greater activity in extension and external rotation of the shoulder, and in abduction in the scapular and frontal planes at 90° and 120° angulations, in addition to its activity being related to pattern II of ED. The TI showed greater activity during extension and external rotation of the shoulder. There was also greater TI activity in abduction in the scapular plane at 90° and 120°, being related to pattern I of DE. The SA showed greater activity during abduction in the scapular and frontal planes at 90° and 120°, as well as during the lowering phase of flexion and abduction with load. Its activity was related to pattern II of DE. Conclusion: This review revealed that the behavior of the main scapula stabilizing muscles has important changes in overhead athletes with ED, but it has similarities with the changes observed in non-overhead individuals, suggesting that the therapeutic approach would be similar for both populations. Dissertação (Mestrado) 2023-12-01

BACKGROUND Volleyball players as overhead athletes have the highest risk of developing Scapular Dyskinesis. The kinetic chain exercise-approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a Kinetic-Chain-Approach on scapular posture, upper and lower limb performance. The aim of this study was to investigate the adjunctive benefits of Mirror-Cross-Education in a Kinetic-Chain-Approach, in volleyball athletes with SD. METHODS 39 professional volleyball athletes were randomly assigned to three groups of 13 each, two experimental, the Mirror-Cross-Education and Kinetic-Chain-Approach, and one control. Both experimental groups performed a Kinetic-Chain-Approach programme, however, the Mirror-Cross-Education group performed the exercise programme with the addition of two mirrors that allowed athletes to observe their opposite non-dyskinetic scapula. Scapular posture asymmetries in cm, the Y-Balance and the Upper-Quarter YBalance after normalizing by limb length the reach distance in each direction, were assessed before and after performing each intervention for 6 weeks. RESULTS 3x2 two-way Mixed ANOVAs detected significant interactions on scapular posture (p=0.001) on both experimental groups when compared with the control. The Y-Balance and the Upper Quarter Y-Balance scores at both Mirror-Cross-Education and Kinetic-Chain-Approach groups showed significant differences when compared with the control (p

Introducao: A discinese escapular e caracterizada por um desequilibrio no movimento da escapula, provocando assim alteracoes na biomecânica escapular e nos musculos estabilizadores da escapula. Objetivo: O objetivo do estudo e relatar o impacto da cinesioterapia na discinese escapular. Metodo: A pesquisa foi realizada atraves de uma revisao do tipo integrativa de abordagem descritiva qualitativa, permitindo a integracao de estudos experimentais e nao-experimentais. O levantamento dos dados aconteceu nos meses de abril e maio de 2020, nas bases de dados SciELO, PubMed e PEDro, utilizando os descritores: escapula; reabilitacao e discinesia. Foram encontrados 348 artigos, apos a aplicacao dos criterios de inclusao e exclusao selecionou-se 11 para compor este estudo. Resultados: Os resultados apontam que o diagnostico clinico e a base norteadora para o tratamento e, que por meio dos exercicios de alongamento, mobilizacao e fortalecimento e possivel reestabelecer o equilibrio muscular do quadrante escapular. Diante de toda analise realizada atraves da pesquisa, permite-se afirmar que dor no ombro e na regiao cervical e alteracao na mecânica escapular sao caracteristicas apresentadas pelo portador da discinese escapular. Sintomas esses, que nao sendo tratados agravam-se atraves de disfuncoes neurais, tendinopatias, lesao labral, sindrome do impacto e outras. Conclusao: Os exercicios fisioterapeuticos por meio de alongamentos, estabilizacao, facilitacao neuromuscular, mobilizacao e fortalecimento, quando aplicados de forma associada no tratamento proprioceptivo de portadores da discinesia, apresentam resultados significativos.

Background: The knowledge of 3-dimensional scapular kinematics is essential for understanding the pathological lesions of the shoulder and elbow in throwing athletes. Many studies about alterations of the resting scapular position, dynamic scapular motion, or scapular dyskinesis (SD) have been conducted, yet none of them have identified a consistent pattern of altered scapular kinematics in throwing athletes. Hypothesis/Purpose: To analyze the 3-dimensional scapular kinematics of dominant and nondominant arms in baseball players with a pathological condition of the shoulder or elbow. Study Design: Cross-sectional study. Methods: Bilateral scapular positions, consisting of upward rotation (UR), superior translation (ST), internal rotation (IR), protraction (PRO), and anterior tilting (AT) with an arm at rest and at 150° forward elevation, were measured among 319 baseball players with SD using 3-dimensional computed tomography. Angular values of scapula were compared between dominant and nondominant arms with statistical analysis. Level of Evidence: Level III, diagnostic study. Results: The scapular position of dominant arms showed significantly more AT, less ST at rest and more UR and IR and less ST, PRO, and AT at 150° full forward elevation compared with the nondominant arms. The magnitude of mean change of UR, IR, PRO, and AT during arm elevation increased significantly between the paired arms (P value: UR, ST, PRO, and AT: Conclusion: When compared with the nondominant arms, UR, AT, and PRO with the arm at 150° forward elevation of dominant symptomatic arms in baseball players tilted toward positive compensation, whereas IR altered toward negative decompensation. In addition, the angular increment of the scapula increased significantly in dominant symptomatic arms compared with the nondominant arms.

It has been theorized that incorporating strength, speed, and flexibility training regimes may improve the quality of the tennis serve. Efficient stroke quality during the serve improves velocity and diminishes injury risk in tennis players. However, no study in tennis has identified whether adequate musculoskeletal capacity is a factor that helps drive optimal serve mechanics. The aim of this study was to determine whether musculoskeletal capacity could predict efficient serve mechanics. A total of 46 professional women’s tennis players (age: 26 ± 3 years, body mass: 65 ± 5 kg, height: 1.74 ± 0.06 m) were studied. Musculoskeletal capacity parameters were evaluated by the tennis specific screen (TSS) with strength and flexibility measures. Serve mechanics were evaluated using the observational tennis serve analysis (OTSA) tool. The OTSA is scored using a 0–9 system. Multiple regression analysis revealed scapular dyskinesis on the non-dominant side during flexion to be predictive of OTSA score (r2 = 0.14, p-value = 0.008). However, the correlation is weak (r = 0.38), rendering a non-clinically significant relationship between scapular dyskinesis and serve mechanics. None of the other musculoskeletal parameters generated significant relationships to serve mechanics. This study demonstrated that in professional women’s tennis players there is no meaningful relationship between the TSS measurements and OTSA scores. In conclusion, musculoskeletal capacity and serve mechanics are independent of each another, and should be addressed separately.

A 20-year-old female, national-level, synchronized ice skater sustained a midsupraspinatus tendon tear (4 mm) in her left shoulder during a training session. Physical tests identified scapular dysk...

Background: Professional bus drivers report a high prevalence of upper quadrant musculoskeletal pain which could be associated with scapular dyskinesis (SD). However, the evidence for valid and reliable screening methods for this condition is limited as SD among bus drivers is an emerging area of research. Therefore, the main aim of the study was to investigate the reliability of dynamic scapular motion test (DSMT) using video analysis as an accurate method to evaluate SD and to identify patterns of SD among bus drivers. Methods: In total, 32 bus drivers from a private bus company with unilateral upper quadrant musculoskeletal pain participated in the study. The DSMT was conducted and the SD was captured in the video during shoulder flexion–abduction movements. Two investigators analyzed the video recordings and identified the patterns of SD. The intra- and interrater reliability were determined using the percentage of agreement and weighted Kappa coefficients (Kw). Descriptive analysis was used to examine the patterns of SD. Findings: The intra- and interrater reliability of DSMT using video analysis were excellent (Kw coefficient: 0.762–0.878 and 0.87–1.00, respectively). About 56.2% and 53.1% of bus drivers presented SD with the shoulder flexion and abduction movements during DSMT. Medial border prominence (Type II pattern of SD) was identified as the common pattern of SD. Conclusion/Application to practice: The DSMT using video analysis showed excellent intra- and interrater reliability to evaluate SD. Occupational health practitioners can consider DSMT using video analysis to identify SD among people with upper quadrant musculoskeletal pain at the workplace.

Background and Purpose Scapular muscle detachment is a rare orthopedic problem that has been described in the literature in patients following traumatic events involving traction, direct trauma, or a motor vehicle accident. The purpose of this case report is to describe the post-operative rehabilitation following scapular muscle reattachment surgery. Unique to this case report is the patient’s perspective, an orthopedic physical therapist with 25 years of experience. Case Description A 47-year-old female physical therapist experienced a traction injury to bilateral upper extremities during a medical procedure resulting in bilateral rhomboid, and bilateral lower trapezius muscles were detached from the medial scapular border. Reconstruction of the left scapulothoracic musculature occurred five and one-half years post-injury with the right repaired one year later. This case report describes the rehabilitation program that took one-year to recover for each arm with a period of protected motion for 16-weeks and gradual return to function as a manual physical therapist over a period of one-year. Outcomes The American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form and pain-free range of motion was used pre- and postoperatively. Left and right shoulder pre-operative ASES scores were 68 and 72, respectively. At the one-year post-operative the left shoulder was rated at 82 and the right shoulder was 90. Pain-free range of motion was achieved in both arms by one year. Functional limitations requiring strength overhead were the slowest to return and were not completely back at one year following either surgery. Discussion Rehabilitation protocols for scapular muscle reattachment surgery are not commonly available to allow physical therapists to guide their patients and structure a rehabilitation program. This case report provides a sample pre-operative set of educational guidelines and a post-operative protocol for use after scapular reattachment surgery. This case report is unique because it offers a patient perspective who is a physical therapist and underwent this surgery twice. Therefore, providing insight on how to prepare for such a unique operation. The slow recovery is due to three issues 1) the prolonged time from injury to diagnosis created significant muscle wasting and muscular imbalance of surrounding tissues, 2) once this tissue was repaired it requires months of protection to recover, 3) the involved scapulothoracic muscle have to regain adequate strength as the foundation for upper extremity functions. Level of evidence Level 5

To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors.Thirty-five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference - 5°; type 2 SD, internal rotation angle difference 5°; and type 3 SD, upward rotation angle difference 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups.Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p 0.05). No healing failure occurred in the improved SD group (p = 0.037).The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing.IV.

Introduction Scapular dyskinesis (SD) is associated with an increased risk of throwing-related shoulder injury onset, resulting in abnormalities in glenohumeral joint (GH) and scapular motions during pitching. The effects of SD on shoulder motion during pitching remain unknown. This study aimed to investigate kinematic alterations in GH and scapular motions during pitching in baseball players with type I SD. Methods Sixty-seven university and independent-league baseball players with and without SD were included. Pitching motion was measured using an optical three-dimensional motion capture system, and a SD test was conducted to evaluate SD. SD was classified into types I–IV. The inter-rater reliability of SD assessment was calculated using kappa coefficients. Three-dimensional GH and scapular kinematics during pitching motion were analyzed. Results The percentage of agreement representing the inter-rater reliability of SD assessment was 77.6% (52/67; kappa coefficient: 0.72). Overall, 24 and 27 participants were categorized into abnormal (type I SD) and normal group (type IV SD), respectively, with normal scapular motion; one individual with type III SD was excluded. The abnormal group exhibited a significantly increased GH external rotation angle (9°) and decreased scapular posterior tilt angle (6°) during the maximum external rotation period compared with the normal group. Conclusions Baseball players in the abnormal group showed increased GH motion and decreased scapular motion during pitching. The SD test for the evaluation of type I SD can help predict excessive GH external rotation and decreased scapular posterior tilt during pitching.

BACKGROUND: The scapular dyskinesis has been described as a sign of scapular instability due to weakness or imbalance of scapular muscles. OBJECTIVE: The aim of this study was to compare the EMG activity of the periscapular and abdominal muscles of asymptomatic subjects without and with scapular dyskinesis type II during a push-up exercise performed on different surface stability conditions. METHODS: Twenty-seven physically active men were allocated into two groups: the Control group (n= 14); and the Dyskinesis group (n= 13). All participants performed three variations of the push-up exercise: Stable, Push-up with hand instability, and Push-up with hand and feet instability. The EMG activity of serratus anterior, upper (UT), middle (MT) and lower (LT) trapezius, external oblique (EO) and rectus abdominis (RA) was recorded during each task. RESULTS: The control group showed an increase in MT activity (mean difference -3.46 to 8.66) under both instability conditions compared to stable push-ups (p< 0.001). The comparison between groups showed that the control group had higher MT activity (mean difference -10.07 to 13.82) compared to the dyskinesis group under unstable conditions (p< 0.012). CONCLUSION: The insertion of unstable surfaces increased MT activity in the control group only. The insertion of the unstable surface, either the hands or the footrest, did not provide significant effects for the other muscles.

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Level of evidence Expert opinion, Level V.

Background: Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP. Methods: A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups’ comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05 Results: There were no statistically significant differences in participants’ AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also, the results of chi-square test showed that there were not any significant differences in the prevalence of scapular dyskinesis during shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541) and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures. Conclusion: According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.

Background: No studies are available on the effects of scapulothoracic mobilization with neck movement (MWM) on patients with neck pain and scapular dyskinesis. Objective: To investigate the effects of scapulothoracic MWM on neck pain, range of motion (ROM), and function in patients with neck pain who demonstrated scapular dyskinesis.Methods: This was a single-blind, randomized, clinical trial. Forty participants with neck pain and scapular dyskinesis were randomly assigned to one of two 2-week regimens: experimental (scapulothoracic MWM + corrective exercises + tape) or comparison (corrective exercises + tape). The visual analog scale (VAS), pressure pain threshold (PPT), cervical and scapular ROM, and Neck Disability Index (NDI) were measured at baseline, after the third session, and after the sixth session.Results: Pain decreased after the sixth session in both the experimental [mean difference: 3.1; 95% confidence interval (CI): 2.1-4.1] and comparison groups (1.8; 95%CI: 0.81-2.8). PPT and scapular ROM did not change in either group at any session. After the sixth session, the ROM of neck extension, right rotation, and right and left side bending improved significantly (p£ 0.031) in both groups, but did not reach the minimal detectable change. The NDI improved in both the experimental (7.2-10.6; 95%CI: 2.5-15.7) and comparison groups (5.9-10.3; 95%CI: 1.2-15.4). There were no significant differences between the groups in any outcome measure at any session. Conclusions: Adding scapulothoracic MWM to corrective exercises and tape over a 2-week period did not seem to add benefit for pain and function in patients with neck pain with scapular dyskinesis.Trial registration: ClinicalTrials.gov, NCT03046160. Registered 8 February 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT0304616

Alterations of scapular kinematics affect the whole kinematic chain, potentially leading to the impingement syndrome. This is crucial in overhead sports, where athletes perform frequent and quick upper limb actions. In this manuscript, we aimed to assess the extent to which fatigue alters scapulo-thoracic and scapulo-humeral ranges of motion (RoM), as well as scapulo-humeral movement onset during different upper limb actions. Twenty-four young healthy males aged 22 ± 2 years (height: 1.82 ± 0.06 m, body mass: 78.0 ± 7.8 kg) performed three movements (upper limb elevation, scapular-plane abduction, and intra-extra rotation) before and after an isokinetic fatigue protocol (upper limb intra/extra rotation, 32 repetitions at 120 degrees/s). Pre vs. post fatigue RoM of humeral elevation and rotation, scapular retraction/protraction, and rotation and tilt were computed. Humerus-scapula movement delay was also determined. Humerus elevation range reduced during intra/extra humerus rotation in fatigued conditions (p = 0.006). Scapular tilt RoM increased after the fatigue protocol (p = 0.063, large effect). Humerus-scapular movement onset delay reduced in fatigued conditions of about 80 ms (p < 0.001, large effect). In sum, fatigued intra/extra upper limb rotators altered the scapulohumeral rhythm, and joints RoM in movements outside the scapular plane. Rather, movements close to the scapular plane were less prone to fatigue-induced alterations.

Purpose. The purpose of this study is to evaluate the association between ergonomic risk level and scapular dyskinesis in office workers. Methods. This cross-sectional study included office workers...

The aim of the study was to assess the activation profile of scapular stabilizing muscles in dyskinetic asymptomatic people.This is a noninterventional observational study. Two groups of 20 people were included in the study. The first group involved asymptomatic athletes with scapular dyskinesis. The second one included athletes without scapular dysfunction. Muscle activation of upper trapezius, lower trapezius, and serratus anterior were recorded by a surface electromyography during shoulder flexion and shoulder abduction, in unloaded and loaded conditions.A significant increase of the activity of the upper trapezius (between 23% and 31%) and a significant decrease of the activity of the lower trapezius (between 32% and 65%) were observed in the dyskinetic group in comparison with the nondyskinetic group in asymptomatic athletes. A significant increase between 17% and 31% of the activity of the serratus anterior was also observed in dyskinetic people. Likewise, a significant increase approximately 24%-61% and 23%-70% was noted respectively in upper trapezius/lower trapezius and upper trapezius/serratus anterior ratio's in the dyskinetic group.An alteration of periscapular muscular activation exists in dyskinetic asymptomatic people. Future studies will be needed to know whether those alterations increase the risk of shoulder injuries.

Context Deviations in scapular motions and subsequent alterations in associated soft tissues are thought to contribute to overuse shoulder injuries in overhead athletes. Whereas rigid and Kinesio taping are recommended for preventing these injuries, high-level evidence from clinical trials is still needed. Objective To determine and compare the short-term effects of rigid and Kinesio taping on scapular dyskinesis, scapular upward rotation, and pectoralis minor length in asymptomatic overhead athletes. Design Randomized controlled trial. Setting Athletic training rooms. Patients or Other Participants Seventy-two elite asymptomatic overhead athletes (age = 17.00 ± 4.09 years, height = 1.75 ± 0.11 m, mass = 67.26 ± 15.25 kg, body mass index = 21.80 ± 3.00). Intervention(s) We randomly assigned participants to 1 of 4 groups: rigid taping, Kinesio taping, placebo, or control (no taping). For the first 3 groups, we applied tape to the shoulder and scapular region. Main Outcome Measure(s) We evaluated all groups for observable scapular dyskinesis using the scapular dyskinesis test, scapular upward rotation using a digital inclinometer, and pectoralis minor length using the pectoralis minor index at baseline, immediately after taping, and at 60 to 72 hours after taping. Results The scapular dyskinesis percentage (P < .05) decreased and the pectoralis minor index (P < .001) increased immediately and at 60 to 72 hours after taping in the rigid-taping and Kinesio-taping groups. We observed no differences among groups for the change in the pectoralis minor index (P > .05). Scapular upward rotation did not change after taping in any group (P > .05). Conclusions Rigid or Kinesio taping of the shoulder and scapular region improved scapular dyskinesis and pectoralis minor length but did not alter scapular upward rotation. Short-term rigid and Kinesio taping may help improve scapular dyskinesis and pectoralis minor length in overhead athletes.

Objective Alteration of scapular position and motion is called scapular dyskinesis. Scapular dyskinesis is a common clinical problem. Strength of shoulder girdle muscles is important in shoulder motions and stability, so their weakness may lead to scapular dyskinesis. The aim of this study was to compare the maximum voluntary isometric force of shoulder girdle movements in subjects with and without scapular dyskinesis Materials & Methods A case-control study was designed where the participants were selected by nonprobability sampling; 30 subjects with scapular dyskinesis and an average age of 22.95±2.62 years and 30 subjects without scapular dyskinesis and an average age of 22.43±2.50 years. The subjects were instructed to stand with their arms resting on each side of the body. The examiner stood behind them at a distance of 1.5 meter and asked them to elevate their arms to the highest level possible. Scapular dyskinesis test was used to visually examine alteration in scapulohumeral rhythm during arm elevation in sagittal and frontal planes. The shoulder flexion and abduction were repeated for 5 times. At the same time, the examiner rated the scapular movement as normal or observable dyskinesis. The maximal voluntary isometric force of shoulder internal and external rotation on both sides, such as “scaption with external rotation”, “scapular abduction and upward rotation”, “scapular adduction and downward rotation”, “scapular adduction” and “adduction and depression of scapula” were measured with manual Dynamometer. For determining the maximal shoulder isometric rotational force, subjects were positioned prone on tables, arm brought into 90º abduction in frontal plane with 90° elbow flexion and resistance given to distal forearm into shoulder external and internal rotations. The maximal isometric force of scaption (supraspinatus strength) was measured in seated position; shoulder elevated 70º into scapular plane abduction (scaption) with external rotation. The maximal isometric force of scapular abduction and upward rotation was determined in supine position while the arm was elevated to 90º flexion with elbow extension and resistance given against forward pushing. For determining the maximal isometric force of rhomboids and middle trapezius muscles, resistance was given against scapular adduction and downward rotation, and scapular adduction, respectively. The maximal isometric force of lower trapezius was determined in prone position while the arm was elevated to 135º shoulder elevation with elbow extension. Independent t-test was performed to compare the maximal voluntary isometric force of shoulder girdle motions in individuals with and without scapular dyskinesis. Results The mean±SD of age, weight and height of the participants without and with scapular dyskinesis were 22.43±2.50 years/ 22.95±2.62 years, 64.39±13.38 kg/ 65.67(±12.2) kg and 171.35(±11.29) cm/ 173.43(±8.66) cm, respectively. No statistically significant differences were found between the participants of the two groups with regard to the age, weight and height. Our result showed that the isometric force of “scaption with external rotation”, “scapular abduction and external rotation”, “adduction and depression of scapula”, “scapular adduction and downward rotation” and “scapular adduction” were significantly different between the two groups (P

Background The Kerlan-Jobe Orthopaedic Clinic (KJOC) score has been used to describe various parameters of throwing shoulder and elbow function for the return to play after a long period of rehabilitation, such as after ulnar collateral ligament reconstruction. No study has yet to identify how scapular dyskinesis (SD) in baseball players affects the KJOC score. This study investigated the relationship of the KJOC score to SD evaluated in collegiate baseball players with and without upper extremity injury. Materials and methods The study participants were 30 male collegiate baseball players (13 pitchers) belonging to the National Collegiate Athletic Association D-I conference. Participants were assessed with the KJOC instrument in the beginning (PRE) and end (POST) of the season. The SD test was conducted (PRE) in shoulder flexion to identify SD Results The mean value of KJOC score was significantly less in POST than that of PRE for the pitchers with SD (89.3 and 60.5, respectively; P = .001), whereas no difference was found in the KJOC score between PRE and POST for the pitchers without SD. For the position players, no difference in the mean value of KJOC score was found between PRE and POST, regardless of SD. Conclusion The results of this study provide evidence that collegiate baseball pitchers with mild SD may have lower KJOC scores, particularly setup or relief pitchers.

An abnormal motion of the scapula, or scapular dyskinesis (SD), can be effectively treated through conservative therapy. The aim of this study is to evaluate a new specific exercise program to restore normal position. A standardized and specific exercise program was created. In a prospective multi-center approach, patients were randomized into two groups: one group received the specific exercise program over a period of six weeks and the controls received massage therapy. The visual-analog scale, QuickDASH score, SICK scapula rating scale, hand press-up position test, lateral scapular slide test and internal rotation of the shoulder were evaluated. Twenty-eight patients were included in the study: fifteen in the exercise group and thirteen in the control group. Pain levels on the visual analog scale (VAS) were significantly reduced in both groups (exercise p=0.007; control p=0.004). The scores for QuickDASH (p=0.001), SICK scapula rating scale (p=0.003) and hand press-up position test (p=0.026) were significantly improved in the exercise group only. Scapula-focused exercise programs, as well as massage therapy, can effectively relieve pain in patients with SD. However, scapula-focused exercises resulted, specifically, in greater improvement of shoulder function.

STUDY DESIGN: Case-control study. BACKGROUND: A large number of student and professional musicians are affected by long term playing related musculoskeletal disorders (PRMSDs) during their career, with prevalence rates above 80%. OBJECTIVE: To investigate if there were differences between musicians with and without prolonged symptoms of upper quarter PRMSDs in the presence of: (1) scapular dyskinesis; (2) cervical motor control and endurance deficits. METHODS: Seventy-two musicians (24 males; 48 females) were matched based on sex, type of instrument and average hours played per week and assigned to one of two groups: A symptomatic group (mean age 23.3 ± 8.2 years) with history of prolonged PRMSDs (constant symptoms lasting more than one week) during the past year; and a control group (mean age 25 ± 10.5 years) with no history of PRMSDs lasting more than one week. Musicians completed a questionnaire and underwent clinical testing for the presence of scapular dyskinesis and cervical motor control and endurance deficits using the following tests: (1) cervical flexor endurance test; (2) scapular dyskinesis test; and (3) craniocervical flexion test. Assessor blinding as to group assignment was ensured. RESULTS: Participants in the symptomatic group presented with a statistically significant higher prevalence of positive scapular dyskinesis (P < .0001; OR = 7.8) and lower scores for the craniocervical flexion test (P < .0001). CONCLUSION: Musicians with prolonged symptoms of PRMSDs presented with higher prevalence of scapular and cervical motor control deficits detected by standard clinical tests when compared to the control group. LEVEL OF EVIDENCE: Therapy, level 4. CLINICALTRIALS.GOV IDENTIFIER: NCT02267395.

Ein 45-jahriger Volleyballspieler stellt sich mit seit sechs Monaten bestehenden Beschwerden im rechten Schultergelenk vor. Ein Trauma sei nicht erinnerlich. Die Symptome treten vor allem wahrend des Aufschlags und bei Schmetterbewegungen mit Ausstrahlung in den proximalen Oberarm auf. Nachtschmerz oder ein subjektives Instabilitatsgefuhl werden verneint.

A 27-year-old man presented with a 5-year history of left periscapular muscle spasm and constant shoulder pain in activities of daily living. Magnetic resonance imaging (MRI) and physical examinati...

Background: Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR). Purpose: To investigate scapular dyskinesis, proprioception, and functional level after ABR. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living. Results: The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group ( P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls ( P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation ( r = –0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score ( r = 0.58; P = .03). Conclusion: Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.

Study Design Cross-sectional. Background The scapular dyskinesis test (SDT) has demonstrated reliability and validity, but its utility for clinical decision making is unclear. Objectives To characterize the prevalence of scapular dyskinesis in participants with and without shoulder pain, and to determine the influence of blinding to the presence of shoulder pain on prevalence of scapular dyskinesis. Methods Participants (n = 135), 67 with shoulder pain and 68 healthy controls, were included in this study. The SDT was performed by 2 examiners, from a total of 21 physical therapists. The second examiner was blinded to the participant's presence of shoulder pain. The SDT involved participants performing 5 repetitions of shoulder flexion and abduction, while the clinician observed for scapular dyskinesis, as characterized by scapular winging or dysrhythmia. Dyskinesis was rated as normal, subtle, or obvious. Ratings were collapsed into 2 groups, dyskinesis (subtle and obvious) and no dyskinesis (normal), as recommended by expert consensus. Results There were no significant differences for scapular dyskinesis prevalence between the shoulder pain group and control group during the SDT in abduction (shoulder pain, 67.2%; 95% confidence interval [CI]: 0.55, 0.77 and control group, 52.9%; 95% CI: 0.41, 0.64; P = .09) or flexion (shoulder pain, 67.2%; 95% CI: 0.55, 0.77 and control group, 61.8%; 95% CI: 0.50, 0.72; P = .51). There were significant differences (P ≤001) between the examiners' SDT ratings in the shoulder pain group. The unblinded examiner reported a higher prevalence when testing the involved shoulder for dyskinesis in flexion (blinded, 67.7%; 95% CI: 0.56, 0.78 and unblinded, 80%; 95% CI: 0.69, 0.88) and during abduction (blinded, 66.2%; 95% CI: 0.54, 0.76 and unblinded, 78.5%; 95% CI: 0.67, 0.87). Conclusion Scapular dyskinesis as assessed with the SDT is not more prevalent in those with shoulder pain. Rating was influenced by an examiner's knowledge of shoulder pain presence. Scapular dyskinesis may represent normal movement variability. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2017;47(8):530-537. Epub 6 Jul 2017. doi:10.2519/jospt.2017.7268.

Objective: The aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). Methods: A total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). Results: Intensity of pain was significantly decreased in both groups with the treatment (p

Posterior shoulder instability is an entity of low prevalence. An atraumatic etiology makes its diagnosis more difficult owing to the absence of inciting factors. A specific clinical and diagnostic examination is required to make the correct diagnosis. Scapular dyskinesis offers insight into the pathogenesis and thus helps rationalizing conservative treatment as the first choice in most cases. The rehabilitation protocol should be analyzed and customized to correct the abnormal biomechanics of the shoulder, providing a strengthening program to avoid persistence of symptoms or recurrence. Failure of conservative treatment warrants surgical interventions such as arthroscopic stabilization, posterior bone block, or, rarely, shoulder arthrodesis.

Background: Scapular dyskinesis is characterized by altered scapular position and motion. Specifically, excess activation of the Upper trapezius (UT)...