SCAPULAR DYSKINESIS

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SCAPULAR DYSKINESIS ITS RELATION TO SHOULDER
PAIN

• W.Kibler , John McMullen
• J Am Acad Orthop Surg 2003
• A JOURNAL ARTICLE REVIEW

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ARTICLE INCLUDES

• Normal scapular function
• Scapular Dyskinesis
• Methods of classification
• Evaluation techniques

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SCAPULAR DYSKINESIS

• It is defined as observable alterations in the
  position of the scapula the patterns of
  scapular motion in relation to thoracic cage
• The term does not suggest etiology or define
  patterns that correlate with specific shoulder
  injuries
• Classification of scapular dyskinesis patterns
  and positions can help to determine treatment
• Factors responsible
• Bony posture or injury
• contractures other flexibility problems
• Alteration in muscle function

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SCAPULAR EVALUATION SHOULD INCLUDE

• Postural evaluation
• Resting Scapular Evaluation
• Dynamic Evaluation of scapular motion
• Corrective measures

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STATIC EVALUATION

• SCAPULAR EVAL SHOULD BE DONE FROM POSTERIOR
  ASPECT
• FIRSTLY SCAPULA SHOULD BE EVALUATED IN STATIC
  POSITION AS IN LONG-STANDING SCAPULAR
  DYSKINESIS,RESTING WINGING MAY BE SEEN

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DYNAMIC EVALUATION

• Should be examined in both elevating lowering
  phase of motion
• Muscle weakness mild dyskinesis is commonly
  seen in lowering phase of arm movement
• These commonly present as hitch or jump in
  otherwise smooth motion of scapula and may be
  more noticeable with several repetitions

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KIBLERS CLASSIFICATION OF SCAPULAR DYSKINESIS
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TYPE I

• PROMINENCE OF INFERIOR MEDIAL SCAPULAR BORDER
• ABNORMAL ROTATION AROUND TRANSVERSE AXIS
• INDICATES WEAKNESS OF LOWER TRAP, LAT DORSI,
  SERR ANT
• OR
• TIGHT PECT MINOR,MAJOR

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TYPE II

• CLASSIC WINGING
• PROMINENCE OF ENTIRE MEDIAL SCAPULAR BORDER
• ABNORMALROTATION AROUND VERTICAL AXIS
• INDICATES WEAKNESS OF SERR ANT,RHOMBOIDS,ALL
  FIBERS OF TRAP

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TYPE III

• PROMINENCE OF SUPERIOR MEDIAL SCAPULAR BORDER
  WITH SUPEROR TRANSLATION OF ENTIRE SCAPULA
• INDICATES OVERACTIVITY OF LEVATOR SCAPULAE
  IMBALANCE OF UPPER LOWER TRAP FORCE COUPLE

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TESTS PERFORMED TO INDICATE WEAKNESS OF SCAPULAR
MUSCLES

• Isometric scapular pinch test
• Wall push- ups
• Lateral scapular slide test
• Scapular assistance test
• Scapular retraction test

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ISOMETRIC SCAPULAR PINCH TEST

• Scapula can be normally held in retraction with
  isometric pinch for 15 to20 seconds without
  burning pain or muscle weakness
• Scapular ms weakness may manifest as burning pain
  in less than 15 sec.

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WALL PUSH - UPS

• Wall push ups are effective for evaluating
  serratus anterior strength
• Abnormalities may be noted with 5 to 10 Wall push
  ups

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LATERAL SCAPULAR SLIDE TEST

• Inferior medial angle of scapula is palpated
  marked on both the sides
• The reference point on the spine is nearest
  spinous process,which is marked
• Distance is measured on both the sides in three
  different positions,-
• At resting position
• With hands on hips, with fingers anterior thumb
  posterior
• With the arms at 90 degrees with internal
  rotation
• A 1.5 cm asymmetry is the threshold for
  abnormality

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LATERAL SCAPULAR SLIDE TEST
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SCAPULAR ASSISTANCE TEST

• During abduction or forward elevation, assistance
  is provided by manually stabilizing the scapula
  and rotating inferior border of scapula as the
  arm moves
• This proc simulates force couple activity of
  serratus ant and lower trap
• Elimination or modification of symptoms indicate
  these muscles should be major focus in rehab.

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SCAPULAR RETRACTION TEST

• The examiner stabilizes the medial scapular
  border as the arm is elevated or externally
• rotated.
• Relief of impingement symptoms is a positive test

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Guidelines for Integrated Rehabilitation of
Scapular Dyskinesis Exercises Weeks
(estimate) Scapular Motion Thoracic posture
1-3 Trunk flexion/extension/rotation
1-3 Lower abdominal/hip extensor
1-5 Muscular Flexibility Massage 1,
2 Modalities (eg, ultrasound, electronic
stimulation) 1-3 Stretching (eg,
active-assisted, passive, PNF) 1-8 Corner
stretches (pectoralis minor) 1-3 Towel roll
stretches (pectoralis minor) 1-3 Levator
scapulae stretches 1-3 Sleeper position
stretches (shoulder ER) 1-3
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Closed Kinetic Chain Co-contraction
Exercises Weight-shifting 1, 2 Balance
board 1, 2 Scapular clock 1, 2 Rhythmic
ball stabilization 2 Weight-bearing isometric
extension 1, 2 Wall push-up 2 Table
push-up 3-5 Modified to prone push-up
5-8 Axially Loaded AROM Exercise Scaption
slide 2-5 Flexion slide 2-5 Abduction
glide 3-5 Diagonal slides 2-6
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Integrated Open Kinetic Chain Exercises Scapular
motion exercices plus arm elevation
3-8 Unilateral/bilateral tubing pulls with trunk
motion 4-8 Modified lawn mower series
3-6 Dumbbell punches with stride (progressive
height and resistance) 6-8 Lunge series with
dumbbell reaches 5-8 Plyometric Sport-Specific
Exercises Medicine ball toss and catch
6-10 Reciprocal tubing plyometrics 6-10
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THANK YOU

• PRESENTATION ACKNOWLEDGEMENT
• DR. PALLAVI SHIVALKAR
• ASSOCIATE PROFESSOR,
• DR. D .Y PATIL COLLGE OF PHYSIOTHERAPY
• NERUL, NAVI MUMBAI
• THANK YOU MADAM.
• DR. AJIN JAYAN THOMAS