Scapular dyskinesia and its relationship to rotator cuff impingement syndrome

  • 1,997 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
1,997
On Slideshare
0
From Embeds
0
Number of Embeds
2

Actions

Shares
Downloads
48
Comments
0
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • Muscles of the shoulder girdle??Trap attachments?
  • Upward Rotators-UFT/LFT + Serr are the greatest contributors to scapular stability and mobility (Kibler, 2012, p 365)-
  • Downward Rotators
  • due to weak scapular/RC muscules
  • (sensitivity, 78% [arm flexion] and74% [scaption]; positive predictivevalue, 76% [arm flexion] and 78%[scaption])
  • the examiner appliesgentle pressure to push on the inferiormedial scapular angle to assistscapular upward rotation and posteriortilt as the patient elevates thearm
  • From Facebook Page “Trust me I’m a Physiotherapist”
  • From Facebook Page “Trust me I’m a Physiotherapist”
  • From Facebook Page “Trust me I’m a Physiotherapist”
  • From Facebook Page “Trust me I’m a Physiotherapist”
  • Kibler WB, McMullen J: Scapular dyskinesis and its relation to shoulder pain. J Am AcadOrthop Surg.2003;11:142-151.

Transcript

  • 1. + Scapular Dyskinesia and its Relationship to Rotator Cuff Impingement Syndrome Nadir Mawji MSc PT Student Year 2 May 16, 2013
  • 2. +
  • 3. +
  • 4. +
  • 5. + Scapulohumeral Rhythm
  • 6. +
  • 7. +
  • 8. +
  • 9. +
  • 10. + Why Supraspinatus?
  • 11. + Rotator Cuff Impingement Treatment Best Practice  Key messages from Kuhn, 2009:  Exercise is effective as a treatment to reduce pain  Exercise + manual therapy = best outcomes  The literature is not clear on which exercises are best, but must be addressed to individual patient needs (clinical reasoning)
  • 12. + Impingement Syndrome Exercises (Kuhn, 2009)
  • 13. + Impingement Syndrome Exercises (Kuhn, 2009)
  • 14. +
  • 15. +
  • 16. + What is Scapular Dyskinesia?  “Alteration in the normal static or dynamic position or motion of the scapula during coupled scapulohumeral movements.” (Sevinsky, S)  Alters the scapulohumeral rhythm  Scapular dyskinesis identified in (Warner, 1992):  68% of RC problems  100% of GH instability
  • 17. + Less Common Causes of Scapular Dyskinesia  Bony  thoracic kyphosis, clavicular # (non-union), shortened clavicular malunion  Joint  High grade AC instability, AC arthrosis/instability, GH jt internal derangement  Neurologic  Cervical radiculopathy, nerve palsy (long thoracic n, spinal acc n) (Kibler, 2012)
  • 18. +
  • 19. +Common Causes of Scapular Dyskinesia 1. Shortening of pec minor, short head of biceps brachii  Result in anterior tilt + protraction of scapula 2. GH IR deficit Creates “windup” of scapula on thorax with arm in IR or ABD (Kibler, 2012)
  • 20. + 3. Poor Patterning -Serratus activation/strength -loss of posterior tilt/upward rotation -Altered UFT/LFT Force couple -delayed onset of LFT alters upward rotation and reduces posterior tilt (Kibler, 2012) Common Causes of Scapular Dyskinesia
  • 21. + Identification of Scapular Dyskinesia Observation: SICK posture (Burkhart, 2003)  Scapular malposition  Inferior medial border prominence  Coracoid pain and malposition  Dyskinesis of scapular movement
  • 22. + Clinical Examination Findings Dynamic Examination of Flexion/Abd -Pt holds 3-5 lb weight -observe repeated flexion/abd 4- 5 times -prominence of medial border suggestive of scapular dyskinesia sensitivity, 78% [flexion] 74% [scaption] positive predictive value, 76% [flexion] 78% [scaption] (Kibler, 2003)
  • 23. + Scapular Assistance Test  Used in evaluating scapular contributions to impingement and RC strength
  • 24. + Test Time!
  • 25. + Inferior Glide Exercise (LFT)
  • 26. + Low Row (LFT)
  • 27. + Push “Plus” (Serr Ant)
  • 28. + Lawn Mower (LFT progression)
  • 29. + Robbery (LFT Progression)
  • 30. + Summary  Determine if scapular dyskinesia is present  Observe for SICK scapula  Dynamic testing (look for prominent inferior/medial border)  Apply corrective movement and assess for change  If Scapular dyskinesia is present  Address underlying dysfunction  Stretch short pec minor/short head of biceps  Manual therapy to reduce GH IR deficit  LFT/Serr strengthening for poor patterning
  • 31. (Kibler, 2003)
  • 32. + References 1. Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic Analysis of Specific Exercises for Scapular Control in Early Phases of Shoulder Rehabilitation. Am J Sports Med. 2008 Sep 1;36(9):1789–98. 2. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009 Feb;18(1):138–60. 3. Tyler TF, Nicholas SJ, Roy T, Gleim GW. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. The American journal of sports medicine. 2000;28(5):668– 73. 4. Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. Journal of the American Academy of Orthopaedic Surgeons. 2012;20(6):364–72. 5. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003 Apr;11(2):142–51. 6. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome A study using Moire topographic analysis. Clinical orthopaedics and related research. 1992;285:191–9. 7. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641–61. 8. Parsons IM, Apreleva M, Fu FH, Woo SLY. The effect of rotator cuff tears on reaction forces at the glenohumeral joint. J. Orthop. Res. 2002 May;20(3):439–46. 9. Kibler WB. The role of the scapula in athletic shoulder function. The American Journal of Sports Medicine. 1998;26(2):325–37.