Is scapular dyskinesis a real condition or a functional adaptation?

In this document, I will cover: the definition of scapular dyskinesis, the scapulohumeral rhythm, dyskinetic patterns, etiology, subjective and objective assessment, and the latest physiotherapy techniques.

1. SCAPULAR DYSKINESIS by:Inasse alrousi.PT mannoba mahjoub.PT hala taj aldeen.PT aya saad.PT

2. Scapular dyskinesis is not always a medical word. In fact, it has been seen in both asymptomatic and symptomatic patients with shoulder girdle discomfort. this term should only be used when scapular dyskinesis is clearly present.( Hegazy , 2022 ) WHAT’S SICK SCAPULA MEAN? Scapular dyskinesis’ is a disorder characterized by altered scapular mechanics and motion‘ SICK scapula’ (scapular malposition, inferior medial border prominence, coracoid pain and dyskynesis of scapular motion).

3. SCAPULOHUMERAL RHYTHM McClure et al. (2011)

4. DYSKINETIC PATTERNS (BY KIBLER ET AL,2003). Type II dyskinesis Type III dyskinesis Type I dyskinesis

5. ETIOLOGY Shoulder-related: shoulder impingement, rotator cuff injury,clavical frature. Neck-related: mechanical pain syndrome Posture-related: scoliosis/ kyphosis Kinetic chain problems: injury to upper or lower limp

6. SUBJECTIVE ASSESSMENT Patient History: onset, duration, previous injury or surgeries. pain assessment: location, intensity, type of pain. functional limitation: any difficulties in ADL or specific movement. patient perception: asking the patient about own observation and scapular movement .

7. OBJECTIVE ASSESSMENT Visual Inspection: Observing winging or asymmetry. Palpation: detect tenderness, muscle tightness, or abnormalities. Range of Motion (ROM) Testing: Measuring to identify any restrictions. Scapular Dyskinesis Test: identify any abnormal motion patterns.

8. OBJECTIVE ASSESSMENT Scapular Assistance Test SAT: to see if it reduces symptoms.(Burkhart, Morgan and Kibler, 2003) Scapular Reposition Test SRT: to assess changes in pain or function.(McClure et al., 2001) Muscle Performance Testing: scapular stabilizers, lower trapezius, middle trapezius, and serratus anterior. Flexibility Tests: Assessing pectoralis minor, thoracic spine, and posterior capsule of the glenohumeral joint

9. RECENT PHYSIOTHERAPY TECHNIQUES: Scapular Stabilization Exercises: Focus on serratus anterior, lower trapezius. Motor Control: specific drills and feedback mechanisms. Proprioceptive Training: Utilizes unstable surfaces, and resistance bands. Individualized Exercise ‘Tailored Exercises’ taking into account the specific impairments and functional goals of each patient progressively load the scapular muscles, improving strength and endurance over time.

10. RECENT PHYSIOTHERAPY TECHNIQUES: Neuromuscular electrical stimulation can be used to activate and re-educate the scapular stabilizing musculature. Dry needling of myofascial trigger points in the scapular stabilizing muscles has shown promising results in improving scapular kinematics and reducing shoulder pain (Kietrys et al., 2013). Kinesiology taping involves applying elastic therapeutic tape to the skin to provide support and stability to muscles and joints without restricting the range of motion (Mostafavifar, Wertz and Borchers, 2015).

11. RECENT PHYSIOTHERAPY TECHNIQUES: Myofascial Release Techniques: pectoralis minor, upper trapezius, and latissimus dorsi. Biofeedback: Devices that provide real-time feedback on muscle activation and movement patterns can help patients correct dyskinesis. Virtual Reality (VR) Rehabilitation: simulate real-life scenarios and provide immediate feedback, helping patients practice and refine scapular movements

12. CONCLUSION Research findings provide evidence for the long-term effectiveness of various scapular dyskinesis treatment approaches. - Scapular stabilization exercises, manual therapy, neuromuscular reeducation, kinesiology taping, and virtual reality training have shown sustained improvements in scapular control, shoulder function, and pain reduction. - These findings support the integration of these approaches into clinical practice for optimal patient outcomes.

13. REFERENCE: Borstad, J.D. (2006). Resting position variables at the shoulder: evidence to support a posture-impairment association. Physical Therapy, [online] 86(4), pp.549–557. Available at: https://pubmed.ncbi.nlm.nih.gov/16579671/. Borstad, J.D. and Ludewig, P.M. (2005). The Effect of Long Versus Short Pectoralis Minor Resting Length on Scapular Kinematics in Healthy Individuals. Journal of Orthopaedic & Sports Physical Therapy, 35(4), pp.227–238. doi:https://doi.org/10.2519/jospt.2005.35.4.227. Burkhart, S.S., Morgan, C.D. and Kibler, W.Ben. (2003). The disabled throwing shoulder: Spectrum of Pathology Part II: Evaluation and treatment of SLAP lesions in throwers. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(5), pp.531–539. doi:https://doi.org/10.1053/jars.2003.50139. Hegazy, M. (2022). Scapular Dyskinesis. IntechOpen eBooks, (22). doi:https://doi.org/10.5772/intechopen.104852. Kietrys, D.M., Palombaro, K.M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J.M. and Tucker, M. (2013). Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 43(9), pp.620–634. doi:https://doi.org/10.2519/jospt.2013.4668. Ludewig, P.M. and Reynolds, J.F. (2009). The association of scapular kinematics and glenohumeral joint pathologies. The Journal of orthopaedic and sports physical therapy, [online] 39(2), pp.90–104. doi:https://doi.org/10.2519/jospt.2009.2808. McClure, P.W., Michener, L.A., Sennett, B.J. and Karduna, A.R. (2001). Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. Journal of Shoulder and Elbow Surgery, [online] 10(3), pp.269–277. doi:https://doi.org/10.1067/mse.2001.112954. Mostafavifar, M., Wertz, J. and Borchers, J. (2015). A Systematic Review of the Effectiveness of Kinesio Taping for Musculoskeletal Injury. The Physician and Sportsmedicine, 40(4), pp.33–40. doi:https://doi.org/10.3810/psm.2012.11.1986.

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