Scapular Dyskinesia Part II

Scapular Dyskinesia Part II

What is the clinical presentation of scapular dyskinesia?

 

When refereeing to scapular dyskinesia, Burkhart commonly referred  to the acronym of "SICK"-  Scapular malpositioned, Inferior medial border prominence, Coracoid pain, and dysKinsesis of scapular movement.   Upon examination, one shoulder may appear to be lower than the other.  The scapula will present protracted and anteriorly tilted resulting in more prominent medial border and inferior angle of the scapula.  The coracoid will be very tender to palpate secondary to a tight pec minor.  The tight pec minor will lead to an anterior tilt of the scapula.

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During active elevation, when compared bilaterally, an asymmetry in scapular rhythm will be noted.  Shoulder hiking is present with elevation and typically, the patient will present with quick jerking movements, along with jittering upon lowering of the limb secondary to muscle strength inadequacies. 

 

Kiber classifies 3 types of scapular dysfunctions


Type 1:
-Inferior angle present secondary to anterior tilting
-Associated with rotator cugg pathology


Type 2:
-Medial scapular border prominent secondary to protraction/internal rotation
-Associated with GH instability


Type 3:
-Shoulder elevation/hiking during elevation
-Associated with impingement

 

Pain presentation:
-Anterior shoulder pain
-Posterior scap pain
-Superior shoulder pain
-Proximal lateral arm pain
-Insidious onset

 

Special tests

 

-Scapular reposition test
 -Repositions the scapula in proper starting position prior to shoulder elevation
 - + test is a reduction in sxs


-Scapular assistance test
 -Assists scapular mechanics during elevation
 -+ test is reduction in sxs


MMT
-Lower trap
-Middle Trap
-Serratus Anterior

Accessory motions
-Posterior/inferior joint capsular tightness

 

 

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