Scapular Dyskinesis: Causes, Symptoms, and Treatment

What is Scapular Dyskinesis?

Scapular dyskinesis occurs when the scapula moves irregularly or improperly during shoulder movement. Normally, the scapula moves smoothly and symmetrically in coordination with the upper arm, but in cases of scapular dyskinesis, the shoulder blade may become "stuck," "winged," or fail to rotate and stabilize correctly.

Causes of Scapular Dyskinesis

There are several potential causes of scapular dyskinesis, including:

1. Muscle Imbalance:

   • Weakness or tightness in the muscles that control the scapula, such as the serratus anterior, rhomboids, trapezius, and levator scapulae, can lead to poor movement patterns of the shoulder blade.

2. Shoulder Injuries:

   • Previous shoulder injuries, such as rotator cuff tears, shoulder dislocations, or fractures, may affect scapular mechanics due to muscle weakness or joint instability.

3. Postural Issues:

   • Poor posture, such as slouching or rounded shoulders, can alter the natural position of the scapula and interfere with proper movement patterns.

4. Overuse or Repetitive Motion:

   • Activities that involve repetitive overhead movements, such as swimming, throwing, or weightlifting, can stress the muscles around the scapula, leading to abnormal motion.

5. Neurological Conditions:

   • Certain neurological conditions that affect nerve function, such as brachial plexus injuries or stroke, can impair scapular movement.

Symptoms of Scapular Dyskinesis

The signs of scapular dyskinesis can vary depending on the severity of the condition and the underlying cause, but common symptoms include:

1. Shoulder Pain:

   • Pain or discomfort in the shoulder, particularly during activities that involve lifting the arm or reaching overhead, is common. The pain may worsen with repetitive motion or heavy lifting.

2. Altered Shoulder Movement:

   • One of the hallmark symptoms of scapular dyskinesis is an abnormal shoulder movement pattern. You may notice that the shoulder blade appears to "wing" out, elevate excessively, or fail to rotate properly as the arm moves.

3. Muscle Weakness:

   • Weakness in the shoulder or upper back muscles, particularly the muscles around the scapula, can occur, making it difficult to perform certain movements, such as lifting the arm or pushing.

4. Impaired Shoulder Function:

   • Activities requiring overhead motion or pushing/pulling actions may become more difficult, and the individual may experience a decreased range of motion, instability, or a feeling of "locking" in the shoulder.

5. Neck and Upper Back Discomfort:

   • Since scapular dyskinesis can affect the surrounding muscles, some individuals may experience pain or tension in the neck or upper back due to compensatory movement patterns.

Diagnosing Scapular Dyskinesis

Diagnosis of scapular dyskinesis typically involves:

1. Physical Examination:

   • A healthcare professional will assess the movement of the scapula during shoulder motion, looking for irregular patterns, such as "winging" (when the scapula sticks out), or reduced scapular mobility. This may include specific tests such as the scapular dyskinesis test.

2. Shoulder Strength Tests:

   • A series of tests may be used to assess the strength of the muscles around the scapula and shoulder joint. This helps to identify whether muscle imbalances or weaknesses are contributing to dyskinesis.

3. Imaging:

   • In some cases, X-rays, MRI, or CT scans may be used to rule out structural issues in the shoulder joint or scapula. These images can also help evaluate the presence of rotator cuff tears, fractures, or other injuries.

4. Movement Analysis:

   • Some clinicians may use specialized movement analysis systems to capture detailed data on shoulder and scapular motion during different activities. This can help provide a more comprehensive understanding of the dysfunction.

Treatment for Scapular Dyskinesis

Treatment for scapular dyskinesis aims to restore normal scapular function, alleviate pain, and prevent further injury. Treatment approaches may vary depending on the cause and severity of the condition.

Non-Surgical Treatment

1. Physical Therapy:

   • A physiotherapist will design a targeted rehabilitation program focusing on restoring proper scapular movement. This often includes:

     • Strengthening exercises for the scapular stabilizers, such as the serratus anterior, rhomboids, and lower trapezius.

     • Stretching exercises to release tight muscles that may be limiting scapular movement, such as the pectorals or levator scapulae.

     • Postural correction exercises to improve body alignment and prevent compensatory movement patterns.

2. Manual Therapy:

   • Hands-on techniques, such as soft tissue mobilization or joint mobilizations, may be used to relieve muscle tightness, improve scapular mobility, and promote better movement patterns.

3. Taping:

   • Kinesiology taping or other taping methods may be used to provide support to the scapula and help guide proper movement, reducing strain on the muscles and tendons.

4. Rest and Ice:

   • Rest and ice therapy can be helpful if pain or inflammation is present. Applying ice for 15–20 minutes a few times a day can reduce discomfort and swelling.

5. Ergonomic Adjustments:

   • Modifying work or activity environments to promote better posture and reduce repetitive shoulder strain can help prevent further injury. This may involve adjusting desk height, using supportive chairs, or improving lifting techniques.

Surgical Treatment

In rare cases, surgery may be needed if the scapular dyskinesis is caused by structural damage, such as a torn muscle or joint issue, or if conservative treatments do not provide relief. Surgical options may include:

1. Scapular Stabilization Surgery:

   • For cases where there is significant weakness or damage to the muscles around the scapula, surgery to repair or strengthen the muscles may be recommended.

2. Rotator Cuff Repair:

   • If scapular dyskinesis is caused by a rotator cuff injury or tear, surgery to repair the torn tissue may be required.

3. Scapulothoracic Joint Surgery:

   • In very rare cases, surgical intervention to address joint issues within the scapulothoracic region may be necessary.

Recovery and Prognosis

The prognosis for scapular dyskinesis is generally good with appropriate treatment. Most individuals will experience significant improvement in symptoms with physical therapy and exercise rehabilitation.

1. Recovery Time:

   • Recovery from scapular dyskinesis can vary depending on the severity of the dysfunction and the underlying cause. Generally, patients can expect significant improvement within 4 to 12 weeks of treatment, with full recovery taking several months.

2. Preventing Recurrence:

   • Maintaining proper posture, continuing strengthening exercises, and avoiding repetitive overhead activities without proper training can help prevent recurrence of scapular dyskinesis.

Prevention of Scapular Dyskinesis

To reduce the risk of scapular dyskinesis, consider the following:

1. Strengthening Shoulder Muscles:

   • Focus on exercises that strengthen the muscles around the shoulder blade, particularly the serratus anterior, rhomboids, and trapezius.

2. Improving Posture:

   • Maintaining good posture throughout daily activities can reduce strain on the scapula and prevent abnormal movement patterns.

3. Proper Warm-Up:

   • Always warm up before engaging in activities that involve repetitive overhead motions, such as swimming, throwing, or lifting.

4. Avoiding Overuse:

   • Take regular breaks when performing repetitive tasks or movements, especially those that involve the shoulder and arms.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we specialize in the assessment and treatment of scapular dyskinesis. Our physiotherapists will work with you to develop a personalized rehabilitation plan that addresses the underlying causes of your condition and restores normal shoulder function.