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Scapulothoracic Dyskinesia

Scapular dyskinesis is characterized by a visible change in the normal position and movement of the shoulder bone (scapula). If left untreated, it can lead to shoulder injury.

Shoulder dyskinesis is commonly associated with another condition, glenohumeral internal-rotation deficits (GIRD), in which the patient finds it difficult to rotate the arm in an internal arc. Both are classic conditions of overhead throwing sports like baseball and tennis.

Functional anatomy

The shoulder is considered as one of the body’s largest and most complex joints. It has a ball and socket joint formed between the humerus (upper arm bone) and scapula. The two bones are intercepted by a number of muscles and tendons that allow a wide range of motion for the arms.

Coordination of the shoulder joint during arm movement works just like a seal balancing a ball on its nose. If it does not follow the ball, the ball will fall off. Similarly, the scapula should follow the direction of the head of the humerus, which can move in a specific range, within which the head does not fall off the joint.

Causes

Scapular dyskinesis can be caused due to structural abnormalities in the spine, shoulder joint injury, nerve injury, proprioceptive dysfunction and muscle tightness or weakness. Glenohumeral internal rotation deficit is another causative agent for shoulder dyskinesis. GIRD, in turn, occurs due to repeated throwing action associated with certain sports.

Symptoms

Shoulder dyskinesia show symptoms of pain, weakness, excessive movement and loss of range of the shoulder joint, winging scapula, and the inability to lift your arms. Symptoms of GIRD include vague shoulder pain, sometimes no pain at all, with reduced performance in throwing action. On physical examination, the patient shows decreased internal rotation and increased external rotation of the shoulder.

Diagnosis

Your surgeon will gain a detailed history of your physical activities and carefully examine your shoulder in motion. Since GIRD is an associated condition, your surgeon will also examine internal and external rotation of the shoulder.

Treatment

The condition can be managed and treated through physical therapy. A range of exercises, including electric stimulation and massages are recommended to address the following problems:

  • Pain and tissue repair
  • Muscle strengthening
  • Activation of the joint’s range of movement
  • Release of muscle tightness
  • Strengthening shoulder and stabilization of joint
  • Shoulder proprioceptive

Surgery

In rare cases when physical therapy cannot provide relief against GIRD, a surgical procedure involving the release of the affected shoulder joint can be employed using an arthroscope (a small camera).