A case study is used to demonstrate the problem of Scapular Dyskinesia in the overhead throwing athlete, along with the most comprehensive approach to management.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Recognize multiple contributions to scapular dyskinesis
  • Effectively diagnose scapular dyskinesis in an patient suspected of having this condition
  • Identify the two muscles that if dysfunctional, would most likely result in scapular dyskinesis and how treatment of scapular dyskinesis aims at reestablishing their proper functioning
  • Recognize the SICK Scapula on physical exam

Reading Resources:

  1. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. British Journal of Sports Medicine. 2010 Apr;44 (5):300-5.
  2. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003; 11: 142-51.
  3. Lo YP, Hsu YC, Chan KM. Epidemiology of shoulder impingement in upper arm sports events. BrJ Sports Med. 1990;24:173-177.
  4. Warner JJP, Micheli LJ, Arslanian LE, et al. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability: a study using Moiré topographic analysis. Clin Orthop Rel Res. 1992; 285: 191-9.
  5. Madsen PH, Bak K, Jensen S, Welter U. Training induces scapular dyskinesis in pain-free competitive swimmers: a reliability and observational study. Clin J Sport Med. 2011 Mar;21(2):109-13.
  6. Smith J, Dietrich CT, Kotajarvi BR, et al. The effect of scapular protraction on isometric shoulder rotation strength in normal subjects. J Shoulder Elbow Surg. 2006;15:339–43.
  7. Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002; 30: 136-51.
  8. Kugler A, Krüger-Franke M, Reininger S, Trouillier HH, Rosemeyer B. Muscular imbalance and shoulder pain in volleyball attackers. Br J Sports Med. 1996 Sep;30(3):256-9.
  9. Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998; 26: 325-37.
  10. McClure PW, Michener LA, Sennett BJ, et al. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg. 2001; 10: 269-77.
  11. Meyer KE, Saether EE, Soiney EK, Shebeck MS, Paddock KL, Ludewig PM. Three-dimensional scapular kinematics during the throwing motion. J Appl Biomech. 2008 Feb;24(1):24-34.
  12. Merolla G, De Santis E, Sperling JW, Campi F, Paladini P, Porcellini G. Infraspinatus strength assessment before and after scapular muscles rehabilitation in professional volleyball players with scapular dyskinesis. J Shoulder Elbow Surg. 2010 Dec;19(8): 1256-64.
  13. Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2009 Jan;25(1):40-5.
  14. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005; 35: 227-38.
  15. Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching. A preliminary report. Am J Sports Med. 1985 Jul-Aug;13(4):216-22.
  16. Borsa PA, Sauers EL, Herling DE. Patterns of glenohumeral joint laxity and stiffness in healthy men and women. Med. Sci. Sports. Exerc. 2000; 32(10):1685-90.
  17. Kennedy DJ, Visco CJ, Press J. Current concepts for shoulder training in the overhead athlete. Curr Sports Med Rep. 2009 May-Jun;8(3):154-60. Review.
  18. Laudner KG, Myers JB, Pasquale MR, et al. Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 2006; 36: 485-94.
  19. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003; 19: 641-61.
  20. Reeser JC, Joy EA, Porucznik CA, Berg RL, Colliver EB, Willick SE. Risk factors for volleyball-related shoulder pain and dysfunction. PM R. 2010 Jan;2(1):27-36.
  21. Speer KP, Cavanaugh JT, Warren RF, Day L, Wickiewicz TL. A role for hydrotherapy in shoulder rehabilitation. Am J Sports Med. 1993 Nov-Dec;21(6):850-3.
  22. Schmitt L, Snyder-Mackler L. Role of scapular stabilizers in etiology and treatment of impingement syndrome. J Orthop Sports Phys Ther. 1999; 29: 31-8.
  23. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000; 80: 276-91.
  24. Ellen MI, Gilhool JJ, Rogers DP. Scapular instability: the scapulothoracic joint. Phys Med Rehab Clin North Am. 2000; 11: 755-70.
  25. Von Eisenhart-Rothe R, Jäger A, Englmeier K-H, et al. Relevance of arm position and muscle activity on three-dimensional glenohumeral translation in patients with traumatic and atraumatic shoulder instability. Am J Sports Med. 2002; 30: 514-22.
  26. Von Eisenhart-Rothe R, Matsen FA, Eckstein F, et al. Pathomechanics in atraumatic shoulder instability. Clin Orthop Relat Res 2005; 433: 82-9.
  27. Su KPE, Johnson MP, Gracely EJ, et al. Scapular rotation in swimmers with and without impingement syndrome: practice effects. Med Sci Sports Exerc 2004; 36: 1117-23.
  28. McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther. 2006; 86: 1075-90.
  29. McQuade KJ, Dawson J, Smidt GL. Scapulothoracic muscle fatigue associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation. J Orthop Sports Phys Ther. 1998; 28: 74-80.
  30. Moraes GF, Faria CD, Teixeira-Salmela LF. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. J. Shoulder Elbow Surg. 2008; 17(1 suppl):48S-53S.
  31. Tsai N-T, McClure PW, Karduna AR. Effects of muscle fatigue on 3-dimensional scapular kinematics. Arch Phys Med Rehabil. 2003; 84: 1000-5.
  32. Aval SM, Durand P Jr, Shankwiler JA. Neurovascular injuries to the athlete’s shoulder: Part I. J Am Acad Orthop Surg. 2007 Apr;15(4):249-56. Review.
  33. Aldridge JW, Bruno RJ, Strauch RJ, Rosenwasser MP. Nerve entrapment in athletes. Clin Sports Med 2001;20:95-122.
  34. Aval SM, Durand P Jr, Shankwiler JA. Neurovascular injuries to the athlete’s shoulder: part II. J Am Acad Orthop Surg. 2007 May;15(5):281-9. Review.
  35. Lajtai G, Pfirrmann CW, Aitzetmüller G, Pirkl C, Gerber C, Jost B. The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med. 2009 Jul;37(7):1375-83.
  36. Ringel SP, Treihaft M, Carry M, Fisher R, Jacobs P. Suprascapular neuropathy in pitchers. Am J Sports Med. 1990 Jan-Feb;18(1):80-6.
  37. Oyama S, Myers JB, Wassinger CA, Daniel Ricci R, Lephart SM. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008 Oct-Dec;43(6):565-70.
  38. Uhl TL, Kibler WB, Gecewich B, et al. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy 2009;25:1240–8.
  39. McClure P, Tate AR, Kareha S, et al. A clinical method for identifying scapular dyskinesis, part 1: reliability. J Athl Train 2009;44:160–4.
  40. McQuade KJ, Smidt G. Dynamic scapulohumeral rhythm: the effects of external resistance during elevation of the arm in the scapular plane. J Orthop Sports Phys Ther 1998; 27: 125-33.
  41. Bak K. The practical management of swimmer’s painful shoulder: etiology, diagnosis, and treatment. Clin J Sport Med. 2010 Sep;20(5):386-90.
  42. Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med 2006;34:1643–7.
  43. 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.
  44. Swanik KA, Lephart SM, Swanik CB, et al. The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics. J. Shoulder Elbow Surg. 2002; 11(6):579-86.
  45. Williams S, Whatman C, Hume PA, Sheerin K. Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Med. 2012 Feb 1;42(2):153-64.
  46. Forthomme B, Crielaard JM, Croisier JL. Scapular positioning in athlete’s shoulder: particularities, clinical measurements and implications. Sports Medicine. 2008; 38(5):369-86.

Disclosures:

Doctors Woods, Burnett, and Munin have no relevant relationships with any entities producing healthcare goods or services. Dr. Chimes is a patent holder and part-owner for ActivAided Orthotics.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to 0.5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 9/18/2012 | Last Modified On: 9/18/2012 | Expires: 9/19/2013

This course has been expired.