The Role of Chiropractic Care in Scapular Dyskinesis Treatment

What is Scapular Dyskinesis?

The shoulder is responsible for approximately 16% of all primary care musculoskeletal visits. Many of these patients exhibit an often overlooked, altered shoulder blade position and motion pattern called, "Scapular dyskinesis." The dominant shoulder is affected more frequently. Normal shoulder blade motion is integrated motion between the shoulder blade (scapula) and upper arm bone (humerus) to provide efficient function and joint stability. When this rhythm is disrupted by abnormal scapular motion, the resulting disproportionate humeral shift creates increased stress on the shoulder capsule and rotator cuff.

Muscular imbalance, neurologic injury, or joint pathology are potential causes of scapular dyskinesis. The most common origin of scapular dyskinesis is muscular imbalance resulting from a combination of weakness, tightness, fatigue or altered activation around the shoulder joint. Tightness in the front of the shoulder leads to dyskinesis by placing excessive pull on the shoulder girdle. Scapular Dyskinesis treatment is crucial in addressing the weakness or fatigue in the muscles surrounding the shoulder blade triggers dyskinesis from inadequate stability during elevation of the arm. Scapular dyskinesis diminishes space inside the shoulder joint and can lead to decreased rotator cuff strength, can cause impingement symptoms, and eventual rotator cuff damage. Uncoordinated movement of the scapula and humerus leads to a loss of dynamic stability in the shoulder joint via excessive strain on ligaments of the shoulder.

Scapular dyskinesis cause may be secondary to various shoulder pathology, including AC separation, A/C instability, A/C arthrosis, labral injury, shoulder instability, biceps tendinitis, and prior collar bone or scapula fracture. Neurologic origins of scapular dyskinesis include cervical radiculopathy or peripheral neuropathy in which one may sustain injury to the spinal accessory nerve, long thoracic nerve, or suprascapular nerve.

What Does Scapular Dyskinesis Look and Feel Like?

Although the cause of scapular dyskinesis is linked to a variety of shoulder problems, it may be asymptomatic initially. Up to 76% of healthy college athletes demonstrate some form of asymptomatic scapular asymmetry. When symptomatic, early complaints can include pain in the front or back of the shoulder. Discomfort may radiate downward toward the side of the shoulder or over into the muscles of the neck. Range of motion deficits are possible, and the consequences of long-standing altered mechanics leads to more well-recognized pain syndromes. It is important to address these symptoms with Scapular Dyskinesis treatment to prevent further complications.

Scapular dyskinesis cause becomes more apparent with dynamic testing, particularly during the lowering phase of arm movement. This can present as “winging” or “dumping” where the shoulder blade doesn’t stay flush with the rib cage and can be seen angling outward during movement.

How Do We Treat Scapular Dyskinesis?

Conservative management is capable of producing significant improvements in pain and function, despite the fact that research shows static and dynamic measurements of scapular dyskinesis remain relatively unchanged after care. Research suggests that scapular stability exercises can also improve neck pain outcomes associated with the cause of scapular dyskinesis.

The successful management of scapular dyskinesis requires identifying and addressing all of the causative components. Treatment should begin by restoring flexibility of tightened tissues. Myofascial release and stretching may be necessary and therapeutic tape have been shown to be effective in managing pain. Scapular Dyskinesis treatment should focus on strengthening exercises should be directed at the back side of the shoulder and shoulder blade stabilizing muscles. Rehab of scapular dyskinesis is most effective when muscles are activated in functional patterns versus isolated strengthening. Strengthening exercises should be performed with the patient focusing on scapular retraction, thereby, increasing postural muscle activation. Patients should avoid “shrugging” their shoulders, or otherwise activating the upper trapezius, which is counterproductive to the strengthening one would be working to achieve around and below the shoulder blades. Scapular dyskinesis cause is commonly seen in patients who have poor scapular control and weak stabilizing muscles, which can lead to shoulder injuries and chronic pain.

If you have been suffering with scapular or shoulder pain, schedule an appointment today to see how our doctors can help!