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)
What is Scapular Dyskinesia?
“Alteration in the normal static or dynamic position or motion of
the scapula during coupled scapulohumeral movements.”
Alters the scapulohumeral rhythm
Scapular dyskinesis identified in (Warner, 1992):
68% of RC problems
100% of GH instability
Less Common Causes of Scapular
thoracic kyphosis, clavicular # (non-union), shortened clavicular
High grade AC instability, AC arthrosis/instability, GH jt internal
Cervical radiculopathy, nerve palsy (long thoracic n, spinal acc n)
+Common Causes of Scapular Dyskinesia
1. Shortening of pec
minor, short head of biceps
Result in anterior tilt +
protraction of scapula
2. GH IR deficit
Creates “windup” of
scapula on thorax with arm
in IR or ABD
3. Poor Patterning
-loss of posterior
-Altered UFT/LFT Force couple
-delayed onset of LFT
alters upward rotation and
reduces posterior tilt
Common Causes of Scapular
Identification of Scapular Dyskinesia
Observation: SICK posture (Burkhart, 2003)
Inferior medial border prominence
Coracoid pain and malposition
Dyskinesis of scapular movement
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
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