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)
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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? Review Topic

QID: 1056
1

Isometric shoulder exercises

12%

(57/484)

2

Isokinetic shoulder exercises

8%

(37/484)

3

Closed chain shoulder exercises

16%

(76/484)

4

Coordination of scapular motion with trunk and hip movements

64%

(309/484)

5

Axial loading shoulder exercises

1%

(4/484)

ML 2

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