We have all heard of this basic term before “winging scapula”. What does it mean, and how does this relate to your shoulder pain? Before we go into detail on what a winged scapula is, we have to talk about the medical term. Scapular Dyskinesis or Scapular Dyskinesia is an alteration in the scapular motion and position compared to a “normal” functioning shoulder. Kibler estimated that in 67% to 100% of shoulder injuries, scapular dyskinesis could be found. This is a staggering number and continues to be a hot topic between physical therapists and other healthcare providers. Does scapular dyskinesis cause shoulder pain?Does shoulder pain cause scapular dyskinesis? Does scapular dyskinesis even exist? These are all questions that physical therapists have been asking. Those questions we will leave for another day.
For today, we will focus on what scapular dyskinesis is and how it can be treated. As stated before, scapular dyskinesis is the alteration in scapular motion and is due to a decrease in scapulothoracic muscle strength or control as the arm moves through a variety of movements. Mostly seen in patients who participate in overhead activities often without the proper exercise program to facilitate that activity. The scapulothoracic muscles (Upper Trapezius, Middle Trapezius, Lower Trapezius,and Serratus Anterior) work together to form a force couple which allows for proper movement of the scapula for upward rotation. Those, paired with the deltoid muscles and rotator cuff muscles all work together to create all the movements of the shoulder needed for daily activity or for sport.
Some common injuries that can occur from scapular dyskinesis are; impingement, rotator cuff tears or tendinitis, and SLAP lesions. Treatment for each of the diagnoses listed are different in duration and strategy, however, if the underlying cause isn’t addressed more problems will occur. So, we ask the question, how can we fix scapular dyskinesis?
The process for fixing this diagnosis starts with an in-depth initial examination which will look at specific weaknesses in the scapulothoracic muscles, a lack of scapular mobility, or glenohumeral deficits. After the examination is complete, creating a plan of care that focuses on improving scapulothoracic muscle strength or scapulothoracic muscle control through concentric and eccentric movements is required. Steady progress is always key with a possible prognosis ranging from 4 weeks to 6 months depending on secondary diagnosis.