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Rehabilitation of Scapular Dyskinesis

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Disorders of the Scapula and Their Role in Shoulder Injury

Abstract

Scapular dyskinesis presenting in patients with shoulder pain may have multiple causes related to shoulder impairments or may simply be an incidental finding. The physical examination should assess the impairments related to scapular dyskinesis in order to develop an appropriate rehabilitation program. The key impairments to examine are soft tissue tightness or laxity, muscular deficits of weakness or control, scapular position or movement faults, and the kinetic chain. This chapter will describe treatment and exercise protocols for flexibility deficits and muscular deficits related to the scapula. Attention is also given to the rehabilitation of scapular dyskinesis in the overhead athlete. The selection of key impairments, rehabilitation guidelines for selection, and progression were based on evidence and clinical experience of the authors. The outcomes and effectiveness of scapula-focused rehabilitation programs are presented.

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Abbreviations

ASES:

American Shoulder Elbow Surgeons Shoulder Score—patient self-report section

GRoC:

Global rating of change

NMES:

Neuromuscular electrical stimulation

NS:

Not significant

SANE:

Single Alpha Numeric Evaluation

SAT:

Scapular assistance test

SDQ:

Shoulder disability questionnaire

SRT:

Scapular reposition test

SS :

Statistically significant

SSMP:

Shoulder Symptom Modification Procedure

WORC:

Western Ontario Rotator Cuff Index

References

  1. Kibler WB, Sciascia A. The shoulder at risk: scapular dyskinesis and altered glenohumeral rotation. Oper Tech Sports Med. 2016;24(3):162–9.

    Article  Google Scholar 

  2. Mcquade KJ, Borstad J, De Oliveira AS. Critical and theoretical perspective on scapular stabilization: what does it really mean, and are we on the right track? Phys Ther. 2016;96(8):1162–9.

    Article  PubMed  Google Scholar 

  3. Wright AA, Wassinger CA, Frank M, et al. Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review. Br J Sports Med. 2013;47:886–92.

    Article  PubMed  Google Scholar 

  4. Rabin A, Irrgang JJ, Fitzgerald GK, et al. The intertester reliability of the scapular assistance test. J Orthop Sports Phys Ther. 2006;36:653–60.

    Article  PubMed  Google Scholar 

  5. Tate AR, Mcclure PW, Kareha S, et al. Effect of the scapula reposition test on shoulder impingement symptoms and elevation strength in overhead athletes. J Orthop Sports Phys Ther. 2008;38:4–11.

    Article  PubMed  Google Scholar 

  6. Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther. 2016;23:57–68.

    Article  PubMed  Google Scholar 

  7. Struyf F, Geraets J, Noten S, et al. A multivariable prediction model for the Chronification of non-traumatic shoulder pain: a systematic review. Pain Physician. 2016;19:1–10.

    PubMed  Google Scholar 

  8. Kibler WB, Ludewig PM, Mcclure PW, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the “scapular summit”. Br J Sports Med. 2013;47:877–85.

    Article  PubMed  Google Scholar 

  9. Cools AM, Struyf F, De Mey K, et al. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48:692–7.

    Article  PubMed  Google Scholar 

  10. Laudner KG, Moline MT, Meister K. The relationship between forward scapular posture and posterior shoulder tightness among baseball players. Am J Sports Med. 2010;38:2106–12.

    Article  PubMed  Google Scholar 

  11. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39:90–104.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vermeulen HM, Stokdijk M, Eilers PH, et al. Measurement of three dimensional shoulder movement patterns with an electromagnetic tracking device in patients with a frozen shoulder. Ann Rheum Dis. 2002;61:115–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Wilk KE, Reinold MM, Macrina LC, et al. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health. 2009;1:131–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ellenbecker T, Roetert EP. Age specific isokinetic glenohumeral internal and external rotation strength in elite junior tennis players. J Sci Med Sport. 2003;6:63–70.

    Article  CAS  PubMed  Google Scholar 

  15. Ellenbecker TS, Roetert EP, Bailie DS, et al. Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc. 2002;34:2052–6.

    Article  PubMed  Google Scholar 

  16. Manske R, Wilk KE, Davies G, et al. Glenohumeral motion deficits: friend or foe? Int J Sports Phys Ther. 2013;8:537–53.

    PubMed  PubMed Central  Google Scholar 

  17. Shanley E, Rauh MJ, Michener LA, et al. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39:1997–2006.

    Article  PubMed  Google Scholar 

  18. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39:329–35.

    Article  PubMed  Google Scholar 

  19. Reiman M, Manske R. Functional testing in human performance. Champaign IL: Human Kinetics Publishers; 2009.

    Google Scholar 

  20. Kluemper M, Uhl T, Hazelrigg A. Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers. J Sport Rehabil. 2006;15:58–70.

    Article  Google Scholar 

  21. Lynch SS, Thigpen CA, Mihalik JP, et al. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44:376–81.

    Article  PubMed  Google Scholar 

  22. Ellenbecker T, Kovacs M. A bilateral comparison of anterior shoulder position in elite junior tennis players. J Orthop Sports Phys Ther. 2010;40:A47.

    Google Scholar 

  23. Wang CH, Mcclure P, Pratt NE, et al. Stretching and strengthening exercises: their effect on three-dimensional scapular kinematics. Arch Phys Med Rehabil. 1999;80:923–9.

    Article  CAS  PubMed  Google Scholar 

  24. Laudner KG, Sipes RC, Wilson JT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008;43:359–63.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Manske RC, Meschke M, Porter A, et al. A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health. 2010;2:94–100.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mcclure P, Balaicuis J, Heiland D, et al. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37:108–14.

    Article  PubMed  Google Scholar 

  27. Moore SD, Laudner KG, Mcloda TA, et al. The immediate effects of muscle energy technique on posterior shoulder tightness: a randomized controlled trial. J Ortop Sports Phys Ther. 2011;41:400–7.

    Article  Google Scholar 

  28. Ellenbecker T, Manske R, Sueyoshi T, et al. The acute effects of a contract-relax horizontal cross body adduction stretch on shoulder internal rotation range of motion using a stretch strap. J Orthop Sports Phys Ther. 2016;46:A37.

    Article  Google Scholar 

  29. Salamh PA, Kolber MJ, Hanney WJ. Effect of scapular stabilization during horizontal adduction stretching on passive internal rotation and posterior shoulder tightness in young women volleyball athletes: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96:349–56.

    Article  PubMed  Google Scholar 

  30. Mottram SL, Woledge RC, Morrissey D. Motion analysis study of a scapular orientation exercise and subjects’ ability to learn the exercise. Man Ther. 2007;14:13–8.

    Article  PubMed  Google Scholar 

  31. De Mey K, Danneels LA, Cagnie B, et al. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography. J Orthop Sports Phys Ther. 2013;43:3–10.

    Article  PubMed  Google Scholar 

  32. Kibler WB, Sciascia AD, Uhl TL, et al. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med. 2008;36:1789–98.

    Article  PubMed  Google Scholar 

  33. Castelein B, Cagnie B, Parlevliet T, et al. Serratus anterior or pectoralis minor: which muscle has the upper hand during protraction exercises? Man Ther. 2016;22:158–64.

    Article  PubMed  Google Scholar 

  34. Reijneveld EA, Noten S, Michener LA et al. Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review. Br J Sports Med. 2016. Epub Ahead of Print.

    Google Scholar 

  35. Bdaiwi AH, Mackenzie TA, Herrington L, et al. Acromiohumeral distance during neuromuscular electrical stimulation of the lower trapezius and serratus anterior muscles in healthy participants. J Athl Train. 2015;50:713–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of scapular muscle balance—which exercises to prescribe? Am J Sports Med. 2007;35:1744–51.

    Article  PubMed  Google Scholar 

  37. Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004;32:484–93.

    Article  PubMed  Google Scholar 

  38. Castelein B, Cagnie B, Parlevliet T, et al. Scapulothoracic muscle activity during elevation exercises measured with surface and fine wire EMG: a comparative study between patients with subacromial impingement syndrome and healthy controls. Man Ther. 2016;23:33–9.

    Article  PubMed  Google Scholar 

  39. Michener LA, Sharma S, Cools AM, et al. Relative scapular muscle activity ratios are altered in subacromial pain syndrome. J Shoulder Elb Surg. 2016;25(11):1861–7.

    Article  Google Scholar 

  40. Struyf F, Cagnie B, Cools A, et al. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol. 2014;24:277–84.

    Article  PubMed  Google Scholar 

  41. Castelein B, Cagnie B, Cools A. Analysis of the recruitment of superficial and deep scapular muscles in patients with chronic shoulder and neck pain, and implications for rehabilitation exercises [Doctoral thesis]. Belgium: Ghent University; 2016.

    Google Scholar 

  42. Schory A, Bidinger E, Wolf J, et al. A systematic review of the exercises that produce optimal muscle ratios of the scapular stabilizers in normal shoulders. Int J SPorts Phys Ther. 2016;11:321–36.

    PubMed  PubMed Central  Google Scholar 

  43. Castelein B, Cagnie B, Parlevliet T, et al. Superficial and deep scapulothoracic muscle electromyographic activity during elevation exercises in the scapular plane. J Orthop Sports Phys Ther. 2016;46:184–93.

    Article  PubMed  Google Scholar 

  44. Uhl TL, Muir TA, Lawson L. Electromyographical assessment of passive, active assistive, and active shoulder rehabilitation exercises. PM R. 2010;2:132–41.

    Article  PubMed  Google Scholar 

  45. Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther. 2003;33:247–58.

    Article  PubMed  Google Scholar 

  46. Castelein B, Cools A, Parlevliet T, et al. Modifying the shoulder joint position during shrugging and retraction exercises alters the activation of the medial scapular muscles. Man Ther. 2016;21:250–5.

    Article  PubMed  Google Scholar 

  47. De Mey K, Danneels L, Cagnie B, et al. Kinetic chain influences on upper and lower trapezius muscle activation during eight variations of a scapular retraction exercise in overhead athletes. J Sci Med Sport. 2013;16:65–70.

    Article  PubMed  Google Scholar 

  48. Maenhout A, Van Praet K, Pizzi L, et al. Electromyographic analysis of knee push up plus variations: what is the influence of the kinetic chain on scapular muscle activity? Br J Sports Med. 2010;44:1010–5.

    Article  CAS  PubMed  Google Scholar 

  49. Yamauchi T, Hasegawa S, Matsumura A, et al. The effect of trunk rotation during shoulder exercises on the activity of the scapular muscle and scapular kinematics. J Shoulder Elb Surg. 2015;24:955–64.

    Article  Google Scholar 

  50. Clarsen B, Bahr R, Andersson SH, et al. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med. 2014;48:1327–33.

    Article  PubMed  Google Scholar 

  51. Kawasaki T, Yamakawa J, Kaketa T, et al. Does scapular dyskinesis affect top rugby players during a game season? J Shoulder Elb Surg. 2012;21:709–14.

    Article  Google Scholar 

  52. Struyf F, Nijs J, Meeus M, et al. Does scapular positioning predict shoulder pain in recreational overhead athletes? Int J Sports Med. 2014;35:75–82.

    CAS  PubMed  Google Scholar 

  53. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152:S90–8.

    Article  PubMed  Google Scholar 

  54. Uhl TL, Kibler WB, Gecewich B, et al. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25:1240–8.

    Article  PubMed  Google Scholar 

  55. Oyama S, Myers JB, Wassinger CA, et al. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008;43:565–70.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Cools AM, Palmans T, Johansson FR. Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players. J Athl Train. 2014;49:647–53.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Kovacs M, Ellenbecker T. An 8-stage model for evaluating the tennis serve: implications for performance enhancement and injury prevention. Sports Health. 2011;3:504–13.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ryu RK, Mccormick J, Jobe FW, et al. An electromyographic analysis of shoulder function in tennis players. Am J Sports Med. 1988;16:481–5.

    Article  CAS  PubMed  Google Scholar 

  59. Digiovine NM, Jobe FW, Pink M, et al. An electromyographic analysis of the upper extremity in pitching. J Shoulder Elb Surg. 1992;1:15–25.

    Article  CAS  Google Scholar 

  60. Ellenbecker TS, Sueyoshi T, Bailie DS. Muscular activation during plyometric exercises in 90 degrees of glenohumeral joint abduction. Sports Health. 2015;7:75–9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Carter AB, Kaminski TW, Douex Jr AT, et al. Effects of high volume upper extremity plyometric training on throwing velocity and functional strength ratios of the shoulder rotators in collegiate baseball players. J Strength Cond Res. 2007;21:208–15.

    Article  PubMed  Google Scholar 

  62. Baskurt Z, Baskurt F, Gelecek N, et al. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24:173–9.

    Article  PubMed  Google Scholar 

  63. Celik D. Comparison of the outcomes of two different exercise programs on frozen shoulder. Acta Orthop Traumatol Turc. 2010;44:285–92.

    Article  PubMed  Google Scholar 

  64. Moezy A, Sepehrifar S, Solaymani Dodaran M. The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Med J Islam Repub Iran. 2014;28:87.

    PubMed  PubMed Central  Google Scholar 

  65. Mulligan EP, Huang M, Dickson T, et al. The effect of Axioscapular and rotator cuff exercise training sequence in patients with subacromial impingement syndrome: a randomized crossover trial. Int J Sports Phys Ther. 2016;11:94–107.

    PubMed  PubMed Central  Google Scholar 

  66. Struyf F, Nijs J, Mollekens S, et al. Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial. Clin Rheumatol. 2013;32:73–85.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Ann M. Cools PhD, PT

  2. Physiotherapy Associates Scottsdale Sports Clinic, Scottsdale, AZ, USA

    Todd S. Ellenbecker DPT, MS, OCS, SCS, CSCS

  3. Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP-155, Los Angeles, CA, 90089, USA

    Lori A. Michener PhD, PT, ATC

Authors
  1. Ann M. Cools PhD, PT
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  2. Todd S. Ellenbecker DPT, MS, OCS, SCS, CSCS
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  3. Lori A. Michener PhD, PT, ATC
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Corresponding author

Correspondence to Todd S. Ellenbecker DPT, MS, OCS, SCS, CSCS .

Editor information

Editors and Affiliations

  1. Lexington Clinic Orthopedics and Sports Medicine Center, Lexington, Kentucky, USA

    W. Ben Kibler

  2. Eastern Kentucky University, Richmond, Kentucky, USA

    Aaron D. Sciascia

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Cools, A.M., Ellenbecker, T.S., Michener, L.A. (2017). Rehabilitation of Scapular Dyskinesis. In: Kibler, W., Sciascia, A. (eds) Disorders of the Scapula and Their Role in Shoulder Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-53584-5_16

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  • DOI: https://doi.org/10.1007/978-3-319-53584-5_16

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  • Online ISBN: 978-3-319-53584-5

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