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Shoulder Dyskinesia

Do you experience pain in the shoulder? Possibly have limited range of motion? But there does not seem to be an answer or cause as to why or when it started? It could be Shoulder Dyskinesia causing your pain/dysfunction.

What is it?

The shoulder is responsible for about 16% of doctor visits for the musculoskeletal system. Many of these patients have an altered scapular position and motion pattern called “scapular dyskinesis.” 64% percent of patients with glenohumeral instability demonstrate scapular dyskinesis.


The motion between the scapula and the humerus provides efficient function and joint stability. When this rhythm is disrupted by abnormal scapular motion, this causes a humeral shift which creates increased stress on the shoulder joint and the rotator cuff. The dominant shoulder is affected more frequently.


Muscular imbalance, neurological injury, or joint pathology are potential causes of scapular dyskinesis. The most common origin comes from muscular imbalance resulting from a combination of weakness, tightness, fatigue, or altered activation.


Weakness or fatigue in the lower trapezius or serratus anterior triggers dyskinesis because it can cause inadequate acromial elevation. Injury to the spinal accessory nerve, long thoracic nerve, or suprascapular nerve is the cause of scapular dyskinesis in about 5% of cases.


Scapular dyskinesis diminishes subacromial space and leads to a decrease in rotator cuff strength, increases impingement symptoms, and can potentially cause rotator cuff damage. Uncoordinated movement of the scapula and humerus leads to loss of dynamic stability in the glenohumeral joint from excessive strain on the anterior glenohumeral ligaments, with concurrent diminished rotator cuff strength.


100% of patients with shoulder impingement also have scapular dyskinesis.


Excessive cellphone use has been shown to promote scapular dyskinesis.


Dyskinesis can occur from dysfunction in the distal kinetic chain, including hip adductor or core weakness. The consequences of long-standing altered mechanics leads to more localized pain. Hyperkyphosis or “slouched” postures are known to contribute as well.


Symptoms

Up to 76% of healthy college athletes demonstrate some form of asymptomatic scapular asymmetry. When the patient does start becoming symptomatic, the early complaints will be pain in the front or back superior aspects of the shoulder. Discomfort may radiate inferiorly towards the lateral deltoid or superiorly into the trapezius region. Pec minor tightness may generate pain over the front shoulder.


The goal of clinical evaluation is to recognize altered scapular mechanics and identify the underlying causative factors. Assessment will begin with observation for winging or asymmetry. You may notice "drooping" of the affected shoulder.


Scapular dyskinesis becomes more apparent with dynamic testing, particularly during the lowering phase of arm movement. Clinicians should recognize that scapular dyskinesis increases throughout a training session so post-activity evaluation may be more revealing.


Range of motion may be affected by this disorder. Posterior shoulder tightness may limit internal rotation, which leads to scapular protraction and dyskinesis. This is very common in overhead athletes. Palpation from a clinician may show tenderness over the coracoid or subacromial region. Trigger points may be possible in the pectoral, biceps, upper trapezius, and rotator cuff muscles.



Diagnosis

Scapular dyskinesis is solely a clinical diagnosis.


Management

Conservative management is the best treatment to produce significant improvements on pain and function. The successful management of scapular dyskinesis requires identifying and addressing all of the causing factors.


Treatment will begin with restoring flexibility of tight and hypertonic tissues. Myofascial release and stretching may be necessary for the pec minor, biceps, and upper trapezius. PNF stretching has been shown to help with lengthening and releasing muscles.


Manipulation of the lower, middle, and upper thoracic spine have shown to improve activity in the muscles that help stabilize the shoulder blade. The use of manipulative therapy is a preferred method of treatment that may accelerate recovery.


Rehabilitation for this is most effective when muscles are activated in functional patterns verus only isolated strengthening exercises.


Strengthening exercises should be performed with the patient focusing on scapular retraction, which causes more activation in the serratus anterior and trapezius. Patients should always avoid “shrugging” their shoulders, or otherwise activating any of the upper trapezius muscles during exercising.


Patients demonstrating weakness in hip abductors or core musculature may require proximal stabilization prior to implementing more specific scapular stabilization. Scapular stabilization may help assist in restoring scapular thoracic mobility. Research suggests that scapular stability exercises can also improve neck pain outcomes.


Therapeutic taping (Kinesiotape) may provide some benefit for scapular dyskinesis patients.




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