Can clinical observation differentiate individuals with and without scapular dyskinesis?

Abstract

Background: Altered scapular rotation and position have been named scapular dyskinesis. Visual dynamic assessment could be applied to classify this alteration based on the clinical observation of the winging of the inferior medial scapular border (Type I) or of the prominence of the entire medial border (Type II), or by the excessive superior translation of the scapula (Type III). Objective: The aim of this study was to determine if there were differences in scapular rotations (Type I and II) and position (Type III) between a group of subjects with scapular dyskinesis, diagnosed by the clinical observation of an expert physical therapist, using a group of healthy individuals (Type IV). Method: Twenty-six asymptomatic subjects volunteered for this study. After a fatigue protocol for the periscapular muscles, the dynamic scapular dyskinesis tests were conducted to visually classify each scapula into one of the four categories (Type IV dyskinesis-free). The kinematic variables studied were the differences between the maximum rotational dysfunctions and the minimum value that represented both normal function and a small dysfunctional movement. Results: Only scapular anterior tilt was significantly greater in the type I dyskinesis group (clinical observation of the posterior projection of the inferior angle of the scapula) when compared to the scapular dyskinesis-free group (p=0.037 scapular and p=0.001 sagittal plane). Conclusions: Clinical observation was considered appropriate only in the diagnoses of dyskinesis type I. Considering the lower prevalence and sample sizes for types II and III, further studies are necessary to validate the clinical observation as a tool to diagnose scapular dyskinesis.

The Influence of Test Positions on Clinical Assessment for Scapular Dyskinesis

“…In previous studies regarding visual-based method, the test positions applied were varying [6,7,10,15,16], at rest or with arm elevation in the sagittal, scapular, and coronal planes. However, few studies have investigated the influence of test positions on scapular dyskinesis assessment.…”

Voluntary winging of the scapula: Proposed diagnostic criteria

“…Physical examination systematically involved a comparative static examination of both shoulders, thorax, and neck, at rest, from the front and back views, looking for muscle atrophy, modification or asymmetry of the neck silhouette. Then, dynamic examination analyzed scapulo‐thoracic rhythm from the back view during a wide circumduction of both upper limbs 6,7,11,18‐20 . Special attention was given to muscle wasting and strength (of the infraspinatus, serratus anterior, trapezius, rhomboid major, deltoid, biceps, and triceps muscles), tendon reflex testing of the upper limbs, and medial or lateral position of WS.…”

“…Causes of WS or scapular dyskinesia are diverse and can be related to nerve, muscle, bone, or joint disorders 1‐7 . Neuromuscular disorders produce dynamic dyskinesia, called WS, whereas bone and joint disorders produce mainly static WS or scapular dyskinesia, which is a non‐specific response to a painful condition in the shoulder 8‐12 . Long thoracic nerve (LTN) and spinal accessory nerve (SAN) palsies as well as facio‐scapulo‐humeral dystrophy (FSHD) are the most frequent causes of unilateral dynamic neuromuscular WS 1,6,7 …”

Scapular Dyskinesis: From Basic Science to Ultimate Treatment

“…A sitting hand press-up test can be used to evaluate the posterior displacement of the medial border [104]. However, a clinical evaluation seems to be appropriate only in the diagnosis of dyskinesis type I because of a lack of evidence of the effectiveness for type II and III [64,105]. To quantify the features of SD types I and II, a novel scapulometer has been investigated, resulting in an excellent reliability and validity [95].…”