Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression

Abstract

PurposeTo investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre‐ and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. MethodsThirty‐five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre‐existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < − 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. ResultsTwenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). ConclusionThe prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. Level of evidenceIV.

Early versus delayed rehabilitation protocol after arthroscopic rotator cuff repair

“…On the other hand, there was no statistically significant difference between early and late groups in scapular upward rotation at 45⁰, 90⁰ and 135⁰ ROM of shoulder abduction. Ueda and his colleagues (2019) observed that scapular movement did not recover after rehabilitation to the same level as that of the healthy controls (22). In contrast to this observation, another study reported that small and large RCT patients had higher scapular upward rotation during arm elevations compared to healthy controls (23).…”

Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program

“…Scapular dyskinesis is a common condition in a variety of shoulder disorders, including rotator cuff tears [1][2][3][4][5], with the medio-lateral and anterior-posterior scapular rotations most commonly affected [6]. The evaluation and treatment of scapular dyskinesis are challenging; in particular, finding accurate and repeatable measures to define "how much" scapular movement is dyskinetic and if it is a cause or effect of the rotator cuff tear is objectively difficult [7,8].…”