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Int J Sports Med 2018; 39(10): 782-790
DOI: 10.1055/a-0608-4584
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of a New Exercise Program in the Treatment of Scapular Dyskinesis

Joerg Nowotny
1   Technische Universitat Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
,
Philip Kasten
2   OCC, Orthopädisch Chirurgisches Centrum, Tübingen, Germany
,
Christian Kopkow
3   University of Applied Sciences, Department für Angewandte Gesundheitswissenschaften, Bochum, Germany
,
Achim Biewener
1   Technische Universitat Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
,
Frieder Mauch
4   Sportklinik-Stuttgart, Department Sportorthopädie/Sporttraumatologie Obere Extremität/Schulterprothetik/, Stuttgart, Germany
› Author Affiliations
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Publication History



accepted 28 March 2018

Publication Date:
27 August 2018 (online)

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Abstract

An abnormal motion of the scapula, or scapular dyskinesis (SD), can be effectively treated through conservative therapy. The aim of this study is to evaluate a new specific exercise program to restore normal position. A standardized and specific exercise program was created. In a prospective multi-center approach, patients were randomized into two groups: one group received the specific exercise program over a period of six weeks and the controls received massage therapy. The visual-analog scale, QuickDASH score, SICK scapula rating scale, hand press-up position test, lateral scapular slide test and internal rotation of the shoulder were evaluated. Twenty-eight patients were included in the study: fifteen in the exercise group and thirteen in the control group. Pain levels on the visual analog scale (VAS) were significantly reduced in both groups (exercise p=0.007; control p=0.004). The scores for QuickDASH (p=0.001), SICK scapula rating scale (p=0.003) and hand press-up position test (p=0.026) were significantly improved in the exercise group only. Scapula-focused exercise programs, as well as massage therapy, can effectively relieve pain in patients with SD. However, scapula-focused exercises resulted, specifically, in greater improvement of shoulder function.

Key words

scapular dyskinesis - rehabilitation program - overhead athlete - impingement
 

  • References

  • 1 Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elbow Surg 2006; 15: 324-330
    CrossrefPubMedGoogle Scholar
  • 2 Braman JP, Zhao KD, Lawrence RL, Harrison AK, Ludewig PM. Shoulder impingement revisited: Evolution of diagnostic understanding in orthopedic surgery and physical therapy. Med Biol Eng Comput 2014; 52: 211-219
    CrossrefPubMedGoogle Scholar
  • 3 Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 2003; 19: 641-661
    CrossrefPubMedGoogle Scholar
  • 4 Bury J, West M, Chamorro-Moriana G, Littlewood C. Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: A systematic review and meta-analysis. Man Ther 2016; 25: 35-42
    CrossrefPubMedGoogle Scholar
  • 5 Carbone S, Postacchini R, Gumina S. Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1473-1480
    CrossrefPubMedGoogle Scholar
  • 6 Celenay ST, Kaya DO, Akbayrak T. Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: A prospective, randomised controlled trial. Man Ther 2016; 21: 144-150
    CrossrefPubMedGoogle Scholar
  • 7 Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med 2014; 48: 1327-1333
    CrossrefPubMedGoogle Scholar
  • 8 Cools AM, Struyf F, De MK, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med 2014; 48: 692-697
    CrossrefPubMedGoogle Scholar
  • 9 Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med 2003; 31: 542-549
    CrossrefPubMedGoogle Scholar
  • 10 Cools AM, Witvrouw EE, Declercq GA, Vanderstraeten GG, Cambier DC. Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. Br J Sports Med 2004; 38: 64-68
    CrossrefPubMedGoogle Scholar
  • 11 De MK, Danneels LA, Cagnie B, Huyghe L, Seyns E, Cools AM. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: The effect on trapezius muscle activation measured by surface electromyography. J Orthop Sports Phys Ther 2013; 43: 3-10
    CrossrefPubMedGoogle Scholar
  • 12 Deng S, Chen K, Ma Y, Chen J, Huang M. The influence of test positions on clinical assessment for scapular dyskinesis. PM R 2017; 9: 761-766
    CrossrefPubMedGoogle Scholar
  • 13 Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther 2007; 37: 754-762
    CrossrefPubMedGoogle Scholar
  • 14 Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med 2010; 44: 319-327
    CrossrefPubMedGoogle Scholar
  • 15 Giphart JE, van der Meijden OA, Millett PJ. The effects of arm elevation on the 3-dimensional acromiohumeral distance: a biplane fluoroscopy study with normative data. J Shoulder Elbow Surg 2012; 21: 1593-1600
    CrossrefPubMedGoogle Scholar
  • 16 Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 2009; 25: 40-45
    CrossrefPubMedGoogle Scholar
  • 17 Hardwick DH, Beebe JA, McDonnell MK, Lang CE. A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. J Orthop Sports Phys Ther 2006; 36: 903-910
    CrossrefPubMedGoogle Scholar
  • 18 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 Update. Int J Sports Med 2017; 38: 1126-1131
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Hebert LJ, Moffet H, McFadyen BJ, Dionne CE. Scapular behavior in shoulder impingement syndrome. Arch Phys Med Rehabil 2002; 83: 60-69
    CrossrefPubMedGoogle Scholar
  • 20 Ho CY, Sole G, Munn J. The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Man Ther 2009; 14: 463-474
    CrossrefPubMedGoogle Scholar
  • 21 Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014; 348: g1687
    CrossrefPubMedGoogle Scholar
  • 22 Holtermann A, Mork PJ, Andersen LL, Olsen HB, Sogaard K. The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance. J Electromyogr Kinesiol 2010; 20: 359-365
    CrossrefPubMedGoogle Scholar
  • 23 Hong J, Barnes MJ, Leddon CE, Van RG, Alamar B. Reliability of the sitting hand press-up test for identifying and quantifying the level of scapular medial border posterior displacement in overhead athletes. Int J Sports Phys Ther 2011; 6: 306-311
    PubMedGoogle Scholar
  • 24 Kassolik K, Andrzejewski W, Brzozowski M, Wilk I, Gorecka-Midura L. Ostrowska Krzyżanowski D, Kurpas D. Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain. J Manipulative Physiol Ther 2013; 36: 418-427
    CrossrefPubMedGoogle Scholar
  • 25 Kawasaki T, Yamakawa J, Kaketa T, Kobayashi H, Kaneko K. Does scapular dyskinesis affect top rugby players during a game season?. J Shoulder Elbow Surg 2012; 21: 709-714
    CrossrefPubMedGoogle Scholar
  • 26 Kennedy CA, Beaton DE, Smith P, Van ED, Tang K, Inrig T, Hogg-Johnson S, Linton D, Couban R. Measurement properties of the QuickDASH (disabilities of the arm, shoulder and hand) outcome measure and cross-cultural adaptations of the QuickDASH: a systematic review. Qual Life Res 2013; 22: 2509-2547
    CrossrefPubMedGoogle Scholar
  • 27 Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998; 26: 325-337
    CrossrefPubMedGoogle Scholar
  • 28 Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Uhl T. The disabled throwing shoulder: spectrum of pathology. 10-year update. Arthroscopy 2013; 29: 141-161
    CrossrefPubMedGoogle Scholar
  • 29 Kibler WB, Ludewig PM, McClure P, Uhl TL, Sciascia A. Scapular Summit 2009: introduction. July 16, 2009, Lexington, Kentucky. J Orthop Sports Phys Ther 2009 39: A1-A13
    PubMedGoogle Scholar
  • 30 Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med 2013 47: 877-885
    PubMedGoogle Scholar
  • 31 Kibler WB, McMullen J, Uhl T. Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am 2001; 32: 527-538
    CrossrefPubMedGoogle Scholar
  • 32 Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med 2010; 44: 300-305
    CrossrefPubMedGoogle Scholar
  • 33 Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med 2006; 34: 1643-1647
    CrossrefPubMedGoogle Scholar
  • 34 Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg 2012; 20: 364-372
    CrossrefPubMedGoogle Scholar
  • 35 Kibler WB, Sciascia AD. Introduction to the Second International Conference on Scapular Dyskinesis in Shoulder Injury--the ‘Scapular Summit‘ Report of 2013. Br J Sports Med 2013 47: 874
    PubMedGoogle Scholar
  • 36 Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med 2008; 36: 1789-1798
    CrossrefPubMedGoogle Scholar
  • 37 Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med 2008; 36: 1789-1798
    CrossrefPubMedGoogle Scholar
  • 38 Kopkow C, Lange T, Schmitt J, Kasten P. Interrater reliability of the modified scapular assistance test with and without handheld weights. Man Ther 2015; 20: 868-874
    CrossrefPubMedGoogle Scholar
  • 39 Lange T, Struyf F, Schmitt J, Lutzner J, Kopkow C. The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review. Phys Ther Sport 2017; 26: 64-89
    CrossrefPubMedGoogle Scholar
  • 40 Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 2000; 80: 276-291
    Google Scholar
  • 41 Ludewig PM, Cook TM. Translations of the humerus in persons with shoulder impingement symptoms. J Orthop Sports Phys Ther 2002; 32: 248-259
    CrossrefPubMedGoogle Scholar
  • 42 Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, Laprade RF. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am 2009; 91: 378-389
    CrossrefPubMedGoogle Scholar
  • 43 Maenhout A, Van EV, Van DL, Vanraes A, Cools A. Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Am J Sports Med 2012; 40: 2105-2112
    CrossrefPubMedGoogle Scholar
  • 44 Maenhout A, Van PK, Pizzi L, Van HM, Cools A. Electromyographic analysis of knee push up plus variations: what is the influence of the kinetic chain on scapular muscle activity?. Br J Sports Med 2010; 44: 1010-1015
    CrossrefPubMedGoogle Scholar
  • 45 Main CJ. The importance of psychosocial influences on chronic pain. Pain Manag 2013; 3: 455-466
    CrossrefPubMedGoogle Scholar
  • 46 Manske RC, Meschke M, Porter A, Smith B, Reiman M. A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health 2010; 2: 94-100
    CrossrefPubMedGoogle Scholar
  • 47 McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther 2007; 37: 108-114
    CrossrefPubMedGoogle Scholar
  • 48 McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther 2004; 84: 832-848
    PubMedGoogle Scholar
  • 49 Merolla G, De SE, Campi F, Paladini P, Porcellini G. Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: strength assessment before and after restoration of scapular musculature balance. Musculoskelet Surg 2010; 94: 119-125
    CrossrefPubMedGoogle Scholar
  • 50 Muraki T, Aoki M, Izumi T, Fujii M, Hidaka E, Miyamoto S. Lengthening of the pectoralis minor muscle during passive shoulder motions and stretching techniques: a cadaveric biomechanical study. Phys Ther 2009; 89: 333-341
    CrossrefPubMedGoogle Scholar
  • 51 Nowotny J, Kopkow C, Kasten P, Mauch F. Effective rehabilitation in patients with scapular dyskinesis. Obere Extremität 2016; 11: 40-46
    CrossrefPubMedGoogle Scholar
  • 52 Piraua AL, Pitangui AC, Silva JP, Pereira dos Passos MH, Alves de Oliveira VM, Batista LS, Cappato de Araújo R. Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis. J Electromyogr Kinesiol 2014; 24: 675-681
    CrossrefPubMedGoogle Scholar
  • 53 Plummer HA, Sum JC, Pozzi F, Varghese R, Michener LA. Observational scapular dyskinesis: Known-groups validity in patients with and without shoulder pain. J Orthop Sports Phys Ther 2017; 47: 530-537
    CrossrefPubMedGoogle Scholar
  • 54 Reijneveld EA, Noten S, Michener LA, Cools A, Struyf F. Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review. Br J Sports Med 2017; 51: 436-441
    CrossrefPubMedGoogle Scholar
  • 55 Sciascia A, Cromwell R. Kinetic chain rehabilitation: a theoretical framework. Rehabil Res Pract 2012; 2012: 853037
    CrossrefPubMedGoogle Scholar
  • 56 Shadmehr A, Azarsa MH, Jalaie S. Inter- and intrarater reliability of modified lateral scapular slide test in healthy athletic men. Biomed Res Int 2014; 2014: 384149
    PubMedGoogle Scholar
  • 57 Shadmehr A, Bagheri H, Ansari NN, Sarafraz H. The reliability measurements of lateral scapular slide test at three different degrees of shoulder joint abduction. Br J Sports Med 2010; 44: 289-293
    CrossrefPubMedGoogle Scholar
  • 58 Shields E, Behrend C, Beiswenger T, Strong B, English C, Maloney M, Voloshin I. Scapular dyskinesis following displaced fractures of the middle clavicle. J Shoulder Elbow Surg 2015; 24: e331-e336
    CrossrefPubMedGoogle Scholar
  • 59 Silva RT, Hartmann LG, Laurino CF, Bilo JP. Clinical and ultrasonographic correlation between scapular dyskinesia and subacromial space measurement among junior elite tennis players. Br J Sports Med 2010; 44: 407-410
    CrossrefPubMedGoogle Scholar
  • 60 Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on exercise reporting template (CERT): Explanation and elaboration statement. Br J Sports Med 2016; 50: 1428-1437
    CrossrefPubMedGoogle Scholar
  • 61 Struyf F, Nijs J, Meeus M, Roussel NA, Mottram S, Truijen S, Meeusen R. Does scapular positioning predict shoulder pain in recreational overhead athletes?. Int J Sports Med 2014; 35: 75-82
    Article in Thieme ConnectPubMedGoogle Scholar
  • 62 Tate AR, McClure PW, Kareha S, Irwin D. Effect of the Scapula Reposition Test on shoulder impingement symptoms and elevation strength in overhead athletes. J Orthop Sports Phys Ther 2008; 38: 4-11
    CrossrefPubMedGoogle Scholar
  • 63 van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage for nonspecific shoulder pain: randomized controlled trial. Phys Ther 2015; 95: 1467-1477
    CrossrefPubMedGoogle Scholar
  • 64 Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation?. Phys Ther 2010; 90: 438-449
    CrossrefPubMedGoogle Scholar
  • 65 Worsley P, Warner M, Mottram S, Gadola S, Veeger HE, Hermens H, Morrissey D, Little P, Cooper C, Carr A, Stokes M. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. J Shoulder Elbow Surg 2013; 22: e11-e19
    PubMedGoogle Scholar
  • 66 Yeun YR. Effectiveness of massage therapy for shoulder pain: a systematic review and meta-analysis. J Phys Ther Sci 2017; 29: 936-940
    CrossrefPubMedGoogle Scholar
  • 67 Yoo WG. Effect of the dual-wall pushup plus exercise in patients with scapular dyskinesis with a winged or tipped scapula. J Phys Ther Sci 2015; 27: 2661-2662
    CrossrefPubMedGoogle Scholar