Scapular Dyskinesis Rehabilitation By Kristen Knorr What is

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Scapular Dyskinesis Rehabilitation

• By Kristen Knorr

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What is scapular dyskinesis?

• Scapular dyskinesis is the alteration of the
  normal static or dynamic position and the motion
  of the scapula during scapulohumeral movements.
• Scapular dyskinesia alters the scapulohumeral
  rhythm due to weak scapular and rotator cuff
  musculature.
• This can cause shoulder pain in a number of ways
  due to the malfunctioning of the scapula.

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Shoulder Girdle Anatomy
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Shoulder Girdle Anatomy
http//www.shoulderdoc.co.uk/article.asp?section4
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Scapular Stabilizers

• Trapezius
• Serratus Anterior
• Rhomboids
• Levator Scapulae
• Latissimus dorsi

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Scapular dyskinesis

• There are 4 types
• Type 1 inferior angle prominence
• Type 2 medial border prominence
• Type 3 superior angle elevation
• Type 4 symmetric pattern

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The SICK Scapula

• The term SICK scapula is another way to describe
  scapular dyskinesis.
• SICK scapula - the pathological state of the
  scapula characterized by scapula mal position,
  inferior border prominence, coracoid pain and mal
  position and kinesis abnormalities of the
  scapula.

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Common Sports

• Scapular dyskinesis is most common in baseball
  pitchers and swimmers. Although all overhead
  athletes are prone to this dysfunction.

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Associated Injuries

• Dysfunction in scapular position and mechanics is
  seen in
• 100 of cases of glenohumeral instability
• 68 of those with abnormalities to the rotator
  cuff
• 94 with labral tears.

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Rehabilitation

• Early rehabilitation should aim to improve the
  endurance and strength of the scapular
  stabilizers.
• Low weight, high repetition exercises promote
  muscle hypertrophy and improve fatigue
  resistance.
• Once more normal scapular mechanics have been
  restored, higher weights with lower repetitions
  may be used to promote power.
• Rotator cuff strengthening can begin once a
  stable scapular base has been restored

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Rehabilitation

• Once endurance and strength have improved,
  exercises that promote effective energy transfer
  through the kinetic chain should be added
• Proprioceptive Neuromuscular Facilitation helps
  promote normal scapulohumeral rhythm and improve
  the bodys ability to position the scapula for
  stable energy transfer during functional
  activities.

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Phase 1 Muscle Strengthening and Conditioning

• Avoid any motions that cause pain and use ice to
  control pain and inflammation
• ROM 3 x 30 secs.
• Cross Body Adduction
• Sleeper Stretch
• Manual Internal Rotation
• Pectoralis Major

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Phase 1

• Scapular Stabilizer Strengthening with rubber
  tubing, manually, dumbbells or machines.
• Isometric scapular retraction
• Shoulder shrugs
• Seated rows w/ retraction
• Prone rows
• Push ups w/ a plus

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Phase 1

• Bench press w/ a plus
• Seated flys
• Lat pull downs
• Elevation
• Protraction
• Depression
• Retraction

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Phase 2

• Continue anterior stretching
• Add biceps and IR stretching
• Continue all scapular exercises while increasing
  weight, reps, etc
• Can begin an upper body ergometer
• Cybex if available

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Phase 2

• Rotator Cuff Strength w/ dumbbells or tubing. 3 x
  10.
• internal and external rotation at 0 and 90
• Abduction to 90
• Scaption (empty can)
• Chest pass w/ a medicine ball
• PNF patterns ( D1, D2 flexion and extension)
• Rhythmic Stabilization (closed chain)

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Phase 2

• Phillies shoulder series
• Thumb tacks
• Train whistles
• Statue of liberty

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Phase 3

• The upper body ergometer should increase
  resistance and can be done both forward and
  backward
• Weights and resistance should be increasing for
  all exercises.
• Prone rows can be done on a swiss ball
• Rhythmic stabilization can be done with eyes
  open, eyes closed and supine

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Phase 3

• Sport specific work should begin
• Throwing technique should be corrected and should
  start with short distance throws.
• For other sports they should be able to block,
  tackle, pass, shoot, etc with no pain.

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Functional Activity

• All components of the patients sport should be
  pain free and with correct techniques.
• This can be tested by doing each skill of the
  sport and comparing their motion.
• The patient should no longer have any
  abnormalities when observing the scapula ( no
  inferior angle, medial border, or superior angle
  prominence)

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Functional Activity

• Cybex if available this can be used to determine
  the strength of the shoulder and whether they are
  strong enough to return to play.

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Summary

• Scapular dyskinesis is a malfunctioning of
  scapular movement that can affect the entire
  shoulder.
• It is most commonly seen in baseball pitchers and
  swimmers.
• Strengthening should be focused on scapular
  stabilization as well as rotator cuff
  musculature.

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Questions?