Scapulothoracic dyskinesis is a rare condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction. Scapular dyskinesis (which may also be referred to as SICK scapula syndrome) is an alteration or deviation in the normal resting or active position of the scapula during shoulder movement. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. For most people, the scapula moves in abnormal ways due to the repetitive use of the shoulder. Causes of scapular dyskinesis include Weakness, imbalance, tightness, or detachment of the muscles that control the scapula. Injuries to the nerves that supply the muscles. Injuries to the bones that support the scapula or injuries within the shoulder joint.
Typical scapular dyskinesis symptoms include Weakness in the arm on the affected side – including the arm feeling “dead” or “heavy” Pain and/or tenderness on and around the shoulder blade, particularly on the inner (medial) edge and at the top of the scapula.
Scapular winging involves one or both shoulder blades sticking out from the back rather than lying flat. It can happen as a result of injury or nerve damage. The scapula, or shoulder blades, are flat bones that connect the upper arm to the collar bone. When they come out of place, it can cause scapular winging.
Other Names
- Scapular Dyskinesia
- Scapulothoracic Dyskinesis
- SICK Scapula Syndrome
- Scapular Malpositioning, Inferior medial border prominence, Coracoid pain and malposition and DysKinesis of scapular movement
- Scapular Dysfunction
Pathophysiology
- Role of scapula
- Provides synchronous scapular rotation during humeral motion
- Serves as a stable base for Rotator Cuff activation
- Functions as a link in the kinetic chain
- Scapular dyskinesis definition[3]
- 1: Abnormal static scapular position and/or dynamic scapular motion characterized by medial border prominence
- 2: Inferior angle prominence and/or early scapular elevation or shrugging on arm elevation; and/or
- 3: Rapid downward rotation during arm lowering
Causes
- Injuries that predispose you to developing scapular dyskinesis:
- Acromioclavicular Joint Separation
- Clavicle Fracture
- Rotator Cuff Tear
- Rotator Cuff Tendonitis
- Calcific Tendinitis of the Rotator Cuff
- Shoulder Instability
- Glenoid Labral Tears
- Poor throwing mechanics
- Pathologic Kyphosis
- Neurologic injuries (eg, long thoracic, accessory, or dorsal scapular nerve palsies)
- Acromioclavicular Joint Pain
- Winged Scapula
- Adhesive Capsulitis
- Primary Stabilizers
- Levator Scapulae
- Rhomboid Major, Rhomboid Minor
- Trapezius
- Serratus Anterior
- Secondary Stabilizers
- Acromioclavicular Joint
- Glenohumeral Joint
- Scapulothoracic power imbalance leads to protracted scapula
- Alteration of shoulder mechanics and can cause secondary injuries
- Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Dislocations & Seperations
- Acromioclavicular Joint Separation
- Glenohumeral Dislocation (Acute)
- Sternoclavicular Joint Dislocation
- Glenohumeral Instability (Chronic)
- Arthropathies
- Glenohumeral Arthritis
- Acromioclavicular Joint Arthritis
- Muscle & Tendon Injuries
- Pectoralis Major Injuries
- Pectoralis Minor Injuries
- Proximal Biceps Tendon Injuries
- Scapular Dyskinesis
- Rotator Cuff
- Rotator Cuff Tear
- Rotator Cuff Tendonitis
- Calcific Tendinitis of the Rotator Cuff
- Subcoracoid Impingement Syndrome
- Bursopathies
- Subacromial Bursitis
- Scapulothoracic Bursitis
- Ligament Injuries
- Glenoid Labral Tears
- Neuropathies
- Suprascapular Nerve Injury
- Parsonage-Turner Syndrome
- Quadrilateral Space Syndrome
- Winged Scapula
- Other
- Adhesive Capsulitis
- Paget-Schroetter Syndrome
- Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)
Symptom
Typical scapular dyskinesis symptoms include: Weakness in the arm on the affected side – including the arm feeling “dead” or “heavy” Pain and/or tenderness on and around the shoulder blade, particularly on the inner (medial) edge and at the top of the scapula.
Diagnosis
- History
- (Needs to be updated)
- Physical Exam: Physical Exam Shoulder
- Scapular exam is done primarily posteriorly with shirt removed (if possible) for complete visualization
- Important to evaluate resting posture checking for side-to-side asymmetry, especially inferior or medial border prominence
- Evaluate dynamic scapula position by slow ascent-descent of shoulder 3-5 times
- Special Tests
- Scapular Assistance Test: Support the scapula with forwarding flexion of the shoulder
- Scapular Retraction Test: Retract the scapula manually after a motor exam of the supraspinatus
- Lateral Scapular Slide Test: measure scapular position with arms in different positions
- Isometric Pinch Test: “Pinch” scapula together
- Primarily a clinical diagnosis
- Standard Radiographs Shoulder and other imaging can be used to identify primary diagnosis
Classification
Kibler Classification
- Type I or Inferior dysfunction[5]
- Primary external visual feature is the prominence of the inferior angle
- Most commonly found in patients with rotator cuff dysfunction.
- Type 2 or Medial dysfunction
- Primary external visual feature is the prominence of the entire medial scapular border
- Medial pattern dysfunction most often occurs in patients with glenohumeral joint instability.
- Type 3 or Superior dysfunction
- Characterized by excessive and early elevation of the scapula during upper extremity elevation.
- Most often seen in patients with rotator cuff dysfunction and deltoid-rotator cuff force couple imbalances
Treatment
Nonoperative
- First line treatment
- Primary treatment is directed at the underlying pathology
- Activity modification
- Including correcting of throwing mechanics
- Medications including NSAIDS
- Physical Therapy
- Emphasis on core strengthening, scapular stabilizers, rotator cuff, serratus anterior
- Corticosteroid Injection
Operative
- Indicated only if primary injury or pathology is considered surgical
