Scapular Dyskinesis Rehabilitation

1. Scapular Dyskinesis Rehabilitation By Kristen Knorr

2. What is scapular dyskinesis? Scapular dyskinesis is the alteration of the normal static or dynamic position and the motion of the scapula during scapulohumeral movements. Scapular dyskinesia alters the scapulohumeral rhythm due to weak scapular and rotator cuff musculature. This can cause shoulder pain in a number of ways due to the malfunctioning of the scapula.

3. Shoulder Girdle Anatomy:

4. Shoulder Girdle Anatomy:

5. Scapular Stabilizers: Trapezius Serratus Anterior Rhomboids Levator Scapulae Latissimus dorsi

6. Scapular dyskinesis: There are 4 types: Type 1 � inferior angle prominence Type 2 � medial border prominence Type 3 � superior angle elevation Type 4 � symmetric pattern

7. The �SICK� Scapula: The term SICK scapula is another way to describe scapular dyskinesis. SICK scapula - the pathological state of the scapula characterized by scapula mal position, inferior border prominence, coracoid pain and mal position and kinesis abnormalities of the scapula.

8. Common Sports: Scapular dyskinesis is most common in baseball pitchers and swimmers. Although all overhead athletes are prone to this dysfunction.

9. Associated Injuries: Dysfunction in scapular position and mechanics is seen in: 100% of cases of glenohumeral instability 68% of those with abnormalities to the rotator cuff 94% with labral tears.

10. Rehabilitation: Early rehabilitation should aim to improve the endurance and strength of the scapular stabilizers. Low weight, high repetition exercises promote muscle hypertrophy and improve fatigue resistance. Once more normal scapular mechanics have been restored, higher weights with lower repetitions may be used to promote power. Rotator cuff strengthening can begin once a stable scapular base has been restored

11. Rehabilitation: Once endurance and strength have improved, exercises that promote effective energy transfer through the kinetic chain should be added Proprioceptive Neuromuscular Facilitation helps promote normal scapulohumeral rhythm and improve the body�s ability to position the scapula for stable energy transfer during functional activities.

12. Phase 1: Muscle Strengthening and Conditioning Avoid any motions that cause pain and use ice to control pain and inflammation ROM: 3 x 30 secs. Cross Body Adduction Sleeper Stretch Manual Internal Rotation Pectoralis Major

13. Phase 1: Scapular Stabilizer Strengthening with rubber tubing, manually, dumbbells or machines. Isometric scapular retraction Shoulder shrugs Seated rows w/ retraction Prone rows Push ups w/ a plus

14. Phase 1: Bench press w/ a plus Seated flys Lat pull downs Elevation Protraction Depression Retraction

15. Phase 2: Continue anterior stretching Add biceps and IR stretching Continue all scapular exercises while increasing weight, reps, etc Can begin an upper body ergometer Cybex if available

16. Phase 2: Rotator Cuff Strength w/ dumbbells or tubing. 3 x 10. internal and external rotation at 0 and 90 Abduction to 90 Scaption (empty can) Chest pass w/ a medicine ball PNF patterns ( D1, D2 flexion and extension) Rhythmic Stabilization (closed chain)

17. Phase 2: Phillie�s shoulder series Thumb tacks Train whistles Statue of liberty

18. Phase 3: The upper body ergometer should increase resistance and can be done both forward and backward Weights and resistance should be increasing for all exercises. Prone rows can be done on a swiss ball Rhythmic stabilization can be done with eyes open, eyes closed and supine

19. Phase 3: Sport specific work should begin Throwing technique should be corrected and should start with short distance throws. For other sports they should be able to block, tackle, pass, shoot, etc with no pain.

20. Functional Activity: All components of the patients sport should be pain free and with correct techniques. This can be tested by doing each skill of the sport and comparing their motion. The patient should no longer have any abnormalities when observing the scapula ( no inferior angle, medial border, or superior angle prominence)

21. Functional Activity: Cybex: if available this can be used to determine the strength of the shoulder and whether they are strong enough to return to play.

22. Summary: Scapular dyskinesis is a malfunctioning of scapular movement that can affect the entire shoulder. It is most commonly seen in baseball pitchers and swimmers. Strengthening should be focused on scapular stabilization as well as rotator cuff musculature.

23. Questions?