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Scapulothoracic Dyskinesis

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Topic updated on 06/08/16 2:30pm
Introduction
  • Abnormal scapula motion leading to shoulder impingement and dysfunction
    • cause are multifactorial including
      • neurologic injury
      • pathologic thoracic spine kyphosis
      • periscapular muscle fatigue
      • poor throwing mechanics
      • secondary to pain (shoulder, neck)
  • Epidemiology
    • demographics
      • seen in athletes
  • Pathoanatomy
    • pathoanatomy
      • scapulothoracic power imbalance leads to protraction of scapula
        • leads to alteration of mechanics at glenohumeral joint
          • excessive stress placed on anterior capsule of shoulder and posterosuperior labrum
      • athletes have increased risk of injuring
        • labrum
        • rotator cuff
        • capsule
Anatomy
  • Scapulothoracic joint anatomy 
Presentation
  • Symptoms
    • shoulder pain and dysfunction worse with arm elevation
    • loss of throwing velocity
  • Physical exam 
    • scapulothoracic crepitus
    • affected scapula may be lower and protracted 
    • symptoms relieved with scapula stabilization
Imaging
  • Radiographs
    • recommended views
      • complete shoulder series
    • findings
      • usually unremarkable
Treatment
  • Nonoperative
    • NSAIDs, PT, local injections
      • indications
        • main treatment
      • technique
        • physical therapy with emphasis on   
          • core strengthening
          • scapular stabilizers, serratus anterior, trapezius
          • rotator cuff muscles 
          • teaching proper core mechanics in throwers 

 

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Qbank (1 Questions)

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(OBQ05.170) A 23-year-old professional pitcher complains of posterior shoulder pain. Physical exam is notable for scapular dyskinesis. No intra-articular pathology is found on shoulder MRI. Which of the following should be emphasized in the initial stages of rehabilitation? Topic Review Topic

1. Isometric shoulder exercises
2. Isokinetic shoulder exercises
3. Closed chain shoulder exercises
4. Coordination of scapular motion with trunk and hip movements
5. Axial loading shoulder exercises

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Video demonstates physical exam techniques to assess for scapular dyskinesia.
1/29/2013
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