scapular dyskinesis

A Simple Test for Scapular Dyskinesis You Must Use

A common part of my examinations includes assessing for abnormal scapular position and movement, which can simply be defined as scapular dyskinesis.  Scapular dyskinesis has long been theorized to predispose people to shoulder injuries, although the evidence has been conflicting.

Whenever data is conflicting in research articles, you need to closely scrutinize the methodology.  One particular flaw that I have noticed in some studies looking at the role of scapular dyskinesis in shoulder dysfunction has involved how the assess and define scapular dyskinesis.

Like anything else, when someone has a significant issue with scapular dyskinesis it is very apparent and obvious on examination.  But being able to detect subtle alterations in the movement of the scapula may be more clinically relevant.  There’s a big difference between someone that has a large amount of winging while concentrically elevating their arm versus someone that has a mild issues with control of the scapula while eccentrically lowering their arm.

Most people will not have a large winging of their scapula while elevating their arm.  This represents a more significant issue, such as a nerve injury.  However, a mild amount of scapular muscle weakness can change the way the scapula moves and make it difficult to control while lowering.

 

A Simple Test for Scapular Dyskinesis

One of the simplest assessments you can perform for scapular dyskinesis is watching the scapula move during shoulder flexion.  Performing visual assessment of the scapula during shoulder flexion has been shown to be a reliable and valid way to assess for abnormal scapular movement.

That’s it.  Crazy, right?  That simple!  Yet, I’m still amazed at how many times people tell me no one has ever looked at how well their scapula moves with their shirt off.

However, there is one little tweak you MUST do when performing this assessment…

You have to use a weight in their hand!

Here is a great example of someone’s scapular dyskinesis when performing shoulder flexion with and without an external load.  The photo on the left uses no weight, while the photo on the right uses a 4 pound dumbbell:

scapular dyskinesis

As you can see, the image on the right shows a striking increase in scapular dyskinesis.  I was skeptical after watching him lift his arm without weight in the photo on the left, however, everything became very clear when adding a light weight to the shoulder flexion movement.  With just a light load, the ability to prevent the scapula from winging while eccentrically lowering the arm becomes much more challenging.

I should also note that there was really no significant difference in scapular control or movement during the concentric portion of the motion raising his arms overhead:

scapular winging concentric

This person doesn’t have a significant issue or nerve damage, he simply just needs some strengthening of his scapular muscles.  But if you didn’t observe his scapula with his shirt off or with a dumbbell in his hand, you may have missed it!

 

How to Assess for Scapular Dyskinesis

In this month’s Inner Circle webinar, I am going to show you a live demonstration of how I assess scapular position and movement.  I’ve had past talks on how to assess scapular position and how to treat scapular dyskinesis, however I want to put it all together with a demonstration of exactly how I perform a full scapular movement assessment and go over things I am looking for during the examination.

I’ll be filming the video and posting later this month.  Inner Circle members will get an email when it is posted.

 

 

 

13 replies
  1. Joseph Fonseca
    Joseph Fonseca says:

    Interesting – I will bring this up in my Orthopedics class this week, as we are finishing up the shoulder and I’ve never heard the concept of adding a weight to assess scapular motion. I look forward to hearing you speak next weekend at the PBATS Baseball Medicine Conference.

    Reply
  2. Philipp Steiner
    Philipp Steiner says:

    Thank you very much Mike for posting Articles and Videos about Scapular Dyskinesis. Here in Germany, a lot of clinicians aren’t aware of this topic. I was diagnosed with this condition when i was already 3 years in pain, and i don’t even know how it developed. I am definitely looking forward to this Seminar. Your Inner Circle Membership is one of the best things i did for my rehabilitation education. Thumbs up ;)

    Reply
  3. Ben Fairchild
    Ben Fairchild says:

    Great article, Mike! Awesome example of what a minimal load can do to challenge movement quality. Rate of movement, I have found, similarly challenges the cleanliness of overhead reaching mechanics. Thanks for always providing the best of shoulder training tips with sensible progressions.

    Reply
  4. Peter Anderson
    Peter Anderson says:

    What is your opinion as to the uncertainty in the literature between the whether scapular dyskinesia is the cause or effect of shoulder pain? If the dyskinesia is secondary to shoulder pain,does a positive finding relevant?

    Reply
    • Peter Anderson
      Peter Anderson says:

      Woops sorry about the typos in there! My question: is a positive finding of dyskinesia relevant if it may have been caused by shoulder pain in the first place? Are we sometimes wasting our time trying to correct something that may correct itself if we address the underlying pathology?

      Reply
  5. Teri
    Teri says:

    I seem to be challenged by finding appropriate diagnosis and treatment of scapular dyskinesis. One Ortho said there was nothing he could do and I couldn’t even raise my arm to shoulder height at the time, another that specializes in shoulders diagnosed me with a supraspinatus tear, sent me to a PT and told me I should be well enough to do anything after that…only I feel less aligned and have continuing pain. Any suggestions on finding practioners that are astute in diagnosing and developing the right treatment protocol for scapula dyskinesis?

    Reply
  6. Chad
    Chad says:

    In my personal experience, many of the patients I’ve found with scapular dyskinesia have poor rhomboid activation secondary to impingement of the dorsal scapular nerve from either GH subluxation, over developed UT or strained UT. Once the subluxations reduced or IASTYM’s used to resolve UT tissue limitations the muscle begins to contract correctly and with muscle reeducation It can be corrected.

    Reply

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