scapular dyskinesis. normal anatomy the scapular makes up most of the joints in the shoulder girdle...

Scapular Dyskinesis

Normal Anatomy

• The scapular makes up most of the joints in the shoulder girdle

• Articulates with thorax• Provides an attachment

for stabilising muscles of the glenohumeral joint

Scapular Movements- Elevation and Depression

Scapular Movements- Upward and Downward Rotation

Scapular Movements- Anterior and Posterior Tilting

Scapular Movements- Protraction and Retraction

Pathology

• Alteration in movement of the scapular during shoulder motion

• A ‘Cause’ and/or ‘Effect’ of most shoulder pathologies

Causes

1. Posture2. Nerve Palsy3. Soft Tissue Mobility4. Muscle Weakness

Classification

• Type 1- Inferior Angle Winging– Increased anterior tilt– Lower trapz weakness– Increased thoracic

kyphosis, tight pec minor, short head of biceps

Classification

• Type 2- Medial Border Winging– Increased internal

rotation– Serratus Anterior

weakness

Classification

• Type 3- Superior Medial Border Winging– Shrugging with arm

elevation

Associated Pathologies

• External Impingement• Internal Impingement• Rotator Cuff Tears• SLAP Lesions• Shoulder Instability

Objective

• Observation• Flexion or abduction

with a small weight• Watch for– Winging– Lack of co-ordination or

control– Fast downward rotation

with eccentric lowering

Objective

• Scapular Assistance Test• Manually assist scapular

upward rotation• Change in symptoms?

Objective

• Scapular Repositioning Test

• Manually assist scapular external rotation and posteriorly tilt

• Change in symptoms?

Conservative - Management

• Based on the associated pathology

• Treatment of the scapular dyskinesis– Posture Correction– Restore Normal Mobility– Restore Stability

Conservative - Management

Serratus Anterior

Serratus Anterior

Lower Trapezius

Lower Trapezius

Lower Trapezius

Lower Trapezius

Conservative Management

1. Motor Control and Strength2. Endurance3. Neuromuscular Control4. Return to Sport