Updated: 6/4/2021

Scapulothoracic Dyskinesis

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  • summary
    • Scapulothoracic dyskinesis is a rare condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction.
    • Diagnosis is clinical with presence of scapulothoracic crepitus with a low and protracted scapula
      and symptoms being relieved with scapula stabilization.
    • Treatment involves NSAIDs and physical therapy with emphasis on periscapular muscle and rotator cuff strengthening. 
  • Epidemiology
    • Demographics
      • seen in athletes (baseball pitchers)
  • Etiology
    • Pathophysiology
      • causes are multifactorial including
        • neurologic injury
        • pathologic thoracic spine kyphosis
        • periscapular muscle fatigue
        • poor throwing mechanics
        • secondary to pain (shoulder, neck)
      • 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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Flashcards (1)
Cards
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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?

QID: 8663
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Stretching the posterior capsule and pectoralis minor tendon

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Stretching the posterior capsule and strengthening the subscapularis

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Stretching the posterior capsule and using shoulder plyometrics

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

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(14/394)

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Stretching the anterior capsule and improving pitching mechanics

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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?

QID: 1056
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Isometric shoulder exercises

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Isokinetic shoulder exercises

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Closed chain shoulder exercises

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Coordination of scapular motion with trunk and hip movements

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Axial loading shoulder exercises

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L 2 D

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Evidence (2)
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EXPERT COMMENTS (3)
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