pathology: scapular dyskinesia

yogabook / pathology / scapular dyskinesia

Definition of

Poor mobility or poor movement pattern of the scapula when moving on the trunk (in the scapulothoracic bearing ) or when moving the arm. The main causes are muscular imbalances and weaknesses as well as tears in the muscles of the rotator cuff . In the most common form of scapular dyskinesia, one sees a scapula alata with a lowered, endorotated arm based on a GIRD ( glenohumeral internal rotational deficit ) with additional painful further exorotation of the arm against resistance, based on a shortening of the external rotators and protractors with weakness of the retractors of the arm Scapula , a general weakness of the muscles that fix the scapula to the back, i.e. in addition to the shortened serratus anterior , especially the rhomboids . Signs of subacromial tightness or impingement syndrome can also often be found.

Kibler describes scapular dyskinesia as noticeable when comparing sides and distinguishes three types:

  1. Prominent inferomedial scapular edge due to abnormal rotation around the transverse axis of the scapula ( inferior gapping)
  2. Prominent complete medial scapular edge due to abnormal rotation of the scapula around the longitudinal (vertical) axis ( medial gapping)
  3. superior translation (partial elevation) of the entire scapula with prominence of the superomedial scapular edge ( superior gapping)

Some authors specify fixed ratios for lateral abduction between the movement in the glenohumeral joint and the external rotation of the scapula , i.e. the movement in the scapulothoracic plain bearing , e.g. 1.5: 1. However, such simplified models can quickly lead practice to absurdity, especially since the movement components are very large depend heavily on individual mobility and muscle strength and (especially muscular) resistance. People with good mobility in particular can certainly perform the first 70° of lateral abduction without external rotation of the scapula . Nevertheless, it can be stated that scapular dyskinesia usually shows noticeable deviations from the unaffected side.
A disruption in external rotation can occur if the serratus anterior or trapezius do not work correctly.

Morgan differentiates scapular dyskinesia from SICK scapula , which he defines as follows:

  • S capular malposition
  • I nferior medial border prominence
  • C oracoid pain and malposition
  • dys K inesis of scapular movement

described by him while standing The position of the shoulder blade is characterized by:

In addition, the elevation ability of the scapula is limited. The anterolaterally displaced coracoid leads to constantly increased tension on the pectoralis minor and tenderness at its base. The low position with partial protraction and partial external rotation causes increased tension of the levator scapulae and tenderness at its insertion at the angle superior . The misalignment also has an unfavorable effect on the ACG and usually leads to constant pain there. In addition, the subacromial space is narrowed, which predisposes to impingement . A positive scapular retraction test shows that with the correct (externally reduced) position of the scapula further lateral abduction is possible is not unlikely in the context of the SICK scapula . TOS (arterial, venous and nervous). It is not uncommon for the SICK scapula to be associated with hyperkyphosis of the thoracic spine.

Causes

SICK scapula

  1. bony changes to the cervical spine, thoracic spine , clavicle , e.g. due to fractures
  2. ACG pathologies
  3. Muscle contractures
  4. neurological deficits in the innervation of the relevant muscles
  5. Contractures of the capsular and ligamentous apparatus of the glenohumeral joint

Scapular dyskinesia in general

  1. muscular imbalances
  2. muscles Weaknesses and tears of rotator cuff
  3. Impingement

Predisposing

  1. GIRD

Diagnosis

  1. inspectorate

Symptoms

  1. Visible positional anomaly of the scapula at rest
  2. possibly limited ROM
  3. If applicable, symptoms of comorbidities and complications such as thrower’s shoulder (athlete’s shoulder), rotator cuff lesions and Impingement

Complications

  1. Rotator cuff lesion
  2. Impingement
  3. Thrower shoulder

therapy

  1. PT is carried out conservatively according to Kibler’s three-phase concept. The symptoms usually subside significantly within 3 months.