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 Posture Nerve Palsy Soft Tissue Mobility 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 Motor Control and Strength Endurance Neuromuscular Control Return to Sport