Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations

  • 829 Accesses

  • 37 Citations



To evaluate the incidence of scapular dyskinesis and SICK scapula syndrome (defined as scapular malposition, infero-medial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) in patients treated surgically for acute type III AC dislocation.


Development of scapular dyskinesis and SICK scapula syndrome following conservative treatment has been described in the literature. In the present study, we evaluated 34 patients treated with different surgical techniques for acute type III AC dislocations. Functional outcome, radiographic evaluation of clavicular reduction and scapular kinematics were all evaluated.


Scapular dyskinesis was observed in only 4 (11.7 %) patients, of which only 1 (2.9 % of the sample) was affected by SICK scapula syndrome. Scapular dyskinesis was classified as type I in 3 cases (75 %) and type III in 1 case (25 %). Constant shoulder scores (mean 95.7 points, SD ± 5.3) and Simple Shoulder Test results (mean 11.2 points, SD ± 0.8) were excellent. Recurrence of separation was observed in 4 patients.


Surgical treatment of type III acute AC joint dislocations is associated with a lower incidence of scapular dyskinesis and SICK scapula syndrome, if compared to data reported in the literature on conservative treatment.

Level of evidence

Retrospective study, Level IV.

This is a preview of subscription content, log in to check access.


  1. 1.

    Bagg SD, Forrest WJ (1988) A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J Phys Med Rehabil 67:238–245

  2. 2.

    Bradley JP, Elkousy H (2003) Decision making: operative versus non-operative treatment of acromioclavicular joint injuries. Clin J Sports Med 22:277–290

  3. 3.

    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 19:641–661

  4. 4.

    Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

  5. 5.

    Dumonski M, Mazzocca A, Rios C, Romeo A, Arciero R (2004) Evaluation and management of acromioclavicular joint injuries. Am J Orthop 33:526–532

  6. 6.

    Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III AC dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225

  7. 7.

    Gumina S, Carbone S, Postacchini F (2009) Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 25:40–45

  8. 8.

    Hootman JM (2004) Acromioclavicular dislocation: conservative or surgical therapy. J Athl Train 39:10–11

  9. 9.

    Kibler WB, Sciascia A (2010) Current concepts: scapular dyskinesis. Br J Sports Med 44:300–305

  10. 10.

    Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11:142–151

  11. 11.

    Kibler WB, Uhl TL, Maddux JW, Brooks PW, Zeller B, McMullen J (2002) Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg 11:550–556

  12. 12.

    Kibler WB (2000) Evaluation and diagnosis of scapulothoracic problems in the athlete. Sports Med Arthrosc 8:192–202

  13. 13.

    Lippit SB, Harreyman DT, Matsen FA (1993) A practical tool for evaluating shoulder function. The Simple Shoulder Test. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont, pp 501–518

  14. 14.

    Lizaur A, Sanz-Reig J, Gonzalez-Parreño S (2011) Long-term results of the surgical treatment of type III acromioclavicular dislocations: an update of a previous report. J Bone Joint Surg Br 93(8):1088–1092

  15. 15.

    McClure PW, Minchener LA, Sennet BJ, Karduna AR (2001) Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg 10:269–277

  16. 16.

    McQuade KJ, Dawson J, Smidt GL (1998) Scapulothoracic muscle fatigue associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation. J Orthop Sports Phys Ther 28:74–80

  17. 17.

    Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF (2009) Arthroscopic treatment of acute acromioclavicular dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 12:1511–1515

  18. 18.

    Nissen CW, Chatterjee A (2007) Type III acromioclavicular separation: results on a recent survey on its management. Am J Orthop 36:89–93

  19. 19.

    Rockwood CA Jr (1984) Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Green DP (eds) Fractures in adults, 2nd edn. JB Lippincott, Philadelphia, pp 860–910

  20. 20.

    Rockwood CA Jr, Williams GR Jr, Young DC (1988) Disorder of the acromioclavicular joint. In: Rockwood CA Jr, Matsen FAIII (eds) The shoulder, 2nd edn. WB Saunders, Philadelphia, pp 483–553

  21. 21.

    Rolla PR, Surace MF, Murena L (2004) Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy 20:662–668

  22. 22.

    Spancer EE (2007) Treatment of grade III acromioclavicular joint injuries. A systematic review. Clin Orthop Relat Res 455:38–44

  23. 23.

    Trainer G, Arciero RA, Mazzocca AD (2008) Practical management of grade III acromioclavicular separations. Clin J Sports Med 18:162–166

  24. 24.

    Uhl TL, Kibler WB, Gecewich B, Tripp BL (2009) Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy 11:1240–1248

  25. 25.

    Warner JP, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R (1992) Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome: a study using Moirè topographic analysis. Clin Orthop Relat Res 285:191–199

Download references


The present study has been approved by the responsible authority at the institution where it has been carried out and has been performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

Author information

Correspondence to Ettore Vulcano.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Murena, L., Canton, G., Vulcano, E. et al. Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Knee Surg Sports Traumatol Arthrosc 21, 1146–1150 (2013).

Download citation


  • Acromio-clavicular dislocation
  • Scapular dyskinesis
  • SICK scapula syndrome
  • Surgical treatment