SCAPULAR DYSKINESIS
What is Scapular Dyskinesis
Scapular Dyskinesis or scapular dysfunction refers to the abnormal mobility or function of the scapula.
Dyskinesis describes aberrant scapular position at rest, such as winging of the scapula (excessive prominence of the medial scapular border) and a deviation from normal scapular motion during arm elevation manifesting as a lack of smooth coordinated movement [1].
Scapular Dyskinesis Classification
According to William Kibler classification of scapular dysfunction [2], Type 1 or Inferior dysfunction is visually characterized by the prominence of the inferior angle as a result of anterior tilting of the scapula in the sagittal plane. Inferior pattern presentation is better visualised while in the hands-on-hips position or during eccentric lowering from overhead elevation. This is often a very subtle abnormality and it typically is not a primary complaint by the patient. However, it can be the underlying cause of the presenting shoulder pain.Treatment techniques to address dyskinesis include electrical stimulation [3,4].
The numerous muscles that attach to the scapula are responsible for the complex motions of the scapula, and any deviation from the normal can lead to damage to the rotator cuff, the shoulder labrum and cartilage.
These muscles can become weak from underuse, muscle imbalance, or from an injury that results in either muscle damage or nerve damage that does not allow the correct signals to reach the muscle.
Several studies have stated that mechanoreceptors are responsible for proprioceptive feedback causing neuromuscular control and confer that muscle fatigue, sustained anterior dislocations feasibly affect the join propriocetions [4].
How to treat Scapular Dyskinesis
Stimulation recruits motor units in specific way which is different from physiological muscle recruitment during voluntary contraction and thus is responsible for strength gain. Muscle stimulation increases the metabolic demand compared to voluntary contraction with higher rates of phosphates and higher cell oxygen level. Studies have shown that neuromuscular electrical stimulation with or without voluntary contraction/exercises causes greater strength improvement than voluntary exercise alone and thus indirectly help in improving the joint position sense.
Scapular Dyskinesis stimulation protocol
What is the Scapular Dyskinesis Protocol
The Scapular Dyskinesis Type protocol have been developed for all patients who have a prominence of the lower angle of the scapula both in a static position and during anteposition or abduction movements, Scapular dyskinesis Type I (Kibler Classification [2]).
The Scapular dyskinesis protocol which is available on App, consists in a sequence of 9 exercises with different duration and 3-levels of increasing intensity.
The aim of the rehabilitation session is to stimulate hypoactive muscle group throughout the motion exercises established in the protocol.
Electrode positioning for Scapular Dyskinesis protocol
To make sure that the motion exercises will be effective, the electrodes must be positioned correctly in the area of the nerve supplying the hypoactive muscles:
- The first electrode should be placed inferior to the spina scapulae to stimulate the external rotators (infraspinatus, teres minor and posterior deltoid)
- The second electrode should be placed medially to the margo medialis scapulae to stimulate the scapula retractors (lower trapezius and rhomboids).
Duration of treatment
A minimum 3 sessions of treatment per week over a period of 3 months is suggested. Longer periods of treatment can be indicated.
How do the exercises in the protocol work?
All exercises are concentric to focus on the increase in tone and resistance of the trapezius muscle.
Each exercise is structured to increase the difficulty through the force of gravity as a variable to modify the workload on the stabilizing muscles of the scapula.
The increase the work resistance in some exercises an isometric contraction at the end of the movement is required.
This protocol has been developed in collaboration with:
Dr. Gabriele Fiumana
Rehabilitation Physiotherapist
Poliambulatorio Shoulder Team
Forlì, Italy
Prof. Giuseppe Porcellini
University of Modena & Reggio Emilia
Italy
SUPPORTING LITERATURE
[1] Kibler WB, Ludewig PM, McClure P, et al. Scapular summit 2009: Introduction. July 16, 2009, Lexington, Kentucky. J Orthop Sports Phys Ther. Nov 2009;39(11):A1-a1
[2] Kibler WB et al.Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg.2002;11:550-556.),
[3] Walter D.B. et al. The effect of electrical stimulation versus sham cueing on scapular position during exercise in patients with scapular dyskinesis. The International Journal of Sports Physical Therapy. 2017;12(3): 434
[4] Ishita S et al. Effect of Electrical Muscle Stimulation with Voluntary Contraction and Taping on Joint Position Sense in Asymptomatic Scapular Dyskinesic Patients. Int J Phys Med Rehabil 2014, 2:2
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