Updated: 6/11/2018

Scapulothoracic Dyskinesis

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Introduction
  • Description
    • Scapulothoracic dyskinesis is a condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction
      • causes are multifactorial including
        • neurologic injury
        • pathologic thoracic spine kyphosis
        • periscapular muscle fatigue
        • poor throwing mechanics
        • secondary to pain (shoulder, neck)
      • also known as SICK scapula
  • Epidemiology
    • demographics
      • seen in athletes
  • Pathoanatomy
    • pathoanatomy
      • scapulothoracic power imbalance leads to protraction of scapula
        • leads to alteration of mechanics at glenohumeral joint
          • excessive stress placed on anterior capsule of shoulder and posterosuperior labrum
      • athletes have increased risk of injuring
        • labrum
        • rotator cuff
        • capsule
Anatomy
  • Scapulothoracic joint anatomy 
Presentation
  • Symptoms
    • shoulder pain and dysfunction worse with arm elevation
    • loss of throwing velocity
  • Physical exam 
    • scapulothoracic crepitus
    • affected scapula may be lower and protracted 
    • symptoms relieved with scapula stabilization
Imaging
  • Radiographs
    • recommended views
      • complete shoulder series
    • findings
      • usually unremarkable
Treatment
  • Nonoperative
    • NSAIDs, PT, local injections
      • indications
        • main treatment
      • technique
        • physical therapy with emphasis on   
          • core strengthening
          • scapular stabilizers, serratus anterior, trapezius
          • rotator cuff muscles 
          • teaching proper core mechanics in throwers 
 

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Questions (2)

(SAE07SM.1) A 22-year-old college baseball pitcher reports the recent onset of anterior and posterosuperior shoulder pain in his throwing shoulder. Examination shows a 15-degree loss of internal rotation, tenderness over the coracoid, and a positive relocation test. Radiographs are normal, and an MRI scan without contrast shows no definitive lesions. A rehabilitation program is prescribed. Which of the following regimens should be initially employed? Tested Concept

QID: 8663
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Stretching the posterior capsule and pectoralis minor tendon

28%

(77/271)

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Stretching the posterior capsule and strengthening the subscapularis

49%

(133/271)

3

Stretching the posterior capsule and using shoulder plyometrics

16%

(44/271)

4

Stretching the anterior capsule and strengthening all components of the rotator cuff

4%

(10/271)

5

Stretching the anterior capsule and improving pitching mechanics

2%

(6/271)

L 5 D

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(OBQ05.170) A 23-year-old professional pitcher complains of posterior shoulder pain. Physical exam is notable for scapular dyskinesis. No intra-articular pathology is found on shoulder MRI. Which of the following should be emphasized in the initial stages of rehabilitation? Tested Concept

QID: 1056
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Isometric shoulder exercises

10%

(108/1069)

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Isokinetic shoulder exercises

6%

(68/1069)

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Closed chain shoulder exercises

14%

(150/1069)

4

Coordination of scapular motion with trunk and hip movements

69%

(736/1069)

5

Axial loading shoulder exercises

1%

(6/1069)

L 2 C

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Evidence (2)
VIDEOS (3)
Topic COMMENTS (3)
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