Essay On Scapular Dyskinesia

Introduction
Scapular dyskinesia is close to me due to its relation with my family. My brother has scapular dyskinesis due to his athletic endeavors in swimming and possibly due to some genetic factors that run in our family. This abnormal scapulohumeral rhythm is seen in shoulder instability, at a rate of 67%, and in shoulder impingement, at a rate of 100%. Shoulder injuries tend to be prevalent at a high rate in today’s population due to impact sports, accidents, and ever increasing elderly population. Although seen very frequently in shoulder instability and impingement, there are no statistics on the incidence of this condition as a whole.
Anatomy Overview Scapular dyskinesis is an anatomical dysfunction of the scapula, or more commonly known as the shoulder blade. The scapula is a bone that connects the humerus and the clavicle to the axial skeleton with its muscle attachments and provides stabilization to the arm. The scapula is a triangle bone; relatively flat in shape that forms the shoulder girdle. The scapula has multiple surfaces where muscles originate and attach. These surfaces are the subscapular fossa (costal side), infraspinatus fossa, and supraspinatus fossa (both dorsal side). There is also the scapular spine, glenoid fossa, acromion, and the superior, medial, and lateral borders. The glenoid
fossa is the location where the humerus will insert, forming the shoulder joint. The clavicle, the bone that is part of the shoulder girdle, is extremely important in regards to the stability and function of the scapula.
There are two main joints that the clavicle attaches to: the sternoclavicular joint and the acromioclavicular joint. The SC joint is extremely stable and does not encounter problems except for extreme trauma. The AC joint however, is much more loose in its structure and thus is more susceptible to injury. Focusing more on the AC joint, it is made up of three ligaments: acromioclavicular, coracoclavicular, and coracoacromial ligaments. These help stabilize the shoulder and scapula to keep the scapula tracking
properly.
There are numerous muscles that make up scapular motions, each working to give smooth and gliding movement to the scapula and the arm. The trapezius, the largest scapular muscle, originates at the occipital bone of the skull and inserts on the clavicle, scapular spine, and the acromion. This muscle stabilizes the scapula, allowing the deltoid to act on the arm, elevates, depresses, and retracts the scapula. The levator scapulae is a small muscle that originates on the transverse process of the C1-C4 vertebrae, and inserting on the superior angle of the scapula. This muscle group elevates the scapula, allowing you to shrug your shoulders, and allows for downward rotation. The rhomboid muscles are split into the major and minor portions, and retract the scapula, allow for downward rotation, elevation of scapula, as well as adduct and extend the arm. This muscle originates from the spinous process of C7-T5 and inserts on the medial border of the scapula. Next is the serratus anterior, which originates from ribs 1-9 and inserts on the medial border and inferior angle of the scapula. This muscle helps with protraction of the scapula in motions like punching or tackling, as well as with upward rotation. Lastly, the pectoralis minor is a small muscle that originates on the anterior surface of ribs 3-5, and inserts on the coracoid process of the scapula. This muscle helps with the action of pushing through protraction, depression, and downward rotation. These muscles all have very specific functions that are necessary to the smooth movement of the scapula and shoulder.
Pathology
Scapular dyskinesis has some pathology to thank for its prevalence: muscular imbalance. Due to multiple different injuries, muscles can become either over used and thus strengthened, or can not be used or used minimally, and thus atrophy and weaken.
Causes and Risk Factors
The causes and injuries behind the muscle imbalances are common, yet present problems. To start, the clavicle needs to be strong and stable, especially at the acromioclavicular joint. If there are any injures to the clavicle, the scapula will be negatively affected and lose it’s primary support to the skeleton. Common pathologies are acromioclavicular separations, clavicular fractures, shoulder impingement, rotator cuff injuries, multi-directional instability, and labral tears. This degeneration of the scapula’s movement can be caused by the instability of the clavicle through fractures or joint separations, rotator cuff ligament injuries or tears, glenohumeral joint labrum tears, and inflammation of shoulder muscles, tendons, and nerves. With other shoulder injuries, the muscles will typically not be used often in order for the damaged tissues and bones to heal, albeit causing muscular atrophy and imbalances. The main risk factors are intense overhead activity (i.e. throwing, tennis), overuse, direct trauma, muscle strain, and injury to another portion of the shoulder. Sports and accidents tend to be the most common causes of this because of either the repetitive stresses or the direct and intense impact upon the shoulder. Knowing what causes this dysfunctional movement of the scapula is great, but we need to be able to identity signs of it, especially due to the high prevalence of shoulder injuries today.
Signs and Symptoms
In order to identify if a patient has Scapular Dyskinesis, we need to know the signs and symptoms. They can include, but are not necessarily limited to the following: muscle weakness and imbalance, nerve injury, muscle injury, osteo-ligamentous injury, and proprioceptive dysfunction. These can range from mild to severe, and can typically be observed by the abnormal resting placement of the scapula and by the poor rotation and movement of the scapula when being used. In order to help the patient regain their full mobility back, there needs to be some interventions that we can make.
Interventions
The medical interventions that can be made for this dysfunctional motion are limited in a broad scope. Pharmaceutically we can use pain medications, like ibuprofen or acetaminophen to reduce the swelling and pain that someone may be experiencing. Most of the interventions, however, are through therapy. Therapy will give the patient the proper exercises and stretches in order to strengthen and balance the scapula muscularly. Therapy will also have an impact through identifying the causing problems for the patient, and either halt the problematic situations or help identify smarter and more beneficial alternatives to the situations. Specific therapeutic modalities will be touched upon in the next section.
Exercises
In order to regain the full strength of the patient’s scapular motion, there will be specific exercises and stretches that must be completed for optimal results. One very helpful exercise to strengthen the typically weak serratus anterior is the “serratus punches.” This exercise is completed with an exercise band or other light resistance. The patient protracts the scapulae while attempting to punch the space in front of them. Another exercise to strengthen the scapula is “prone horizontal abduction” with forearm rotation in a hitchhiker’s position. This will help strengthen the lower trapezius and assist with proper tracking of the scapula.