Scapular Dyskinesia in Athletes

Chronic shoulder pain in athletes may be coming from the scapula (shoulder blade). This is most common in overhead athletes. Baseball pitchers or swimmers are affected most often. In this article, Dr. J. D. Kelly, IV from Temple University School of Medicine discusses this particular problem.

Abnormal motion of the scapula is called scapular dyskinesia. Scapular dyskinesia can be observed visually. As the athlete moves his or her arm out to the side and up overhead, the scapula doesn't glide and tilt smoothly like it should.

Most of the shoulder muscles attach to the scapula. And the shoulder socket is part of the scapula. So scapular dyskinesia affects shoulder motion as well. Athletes report pain, stiffness, and impingement during shoulder movement. Impingement refers to the soft tissue around the shoulder getting pinched during certain movements.

Dr. Kelly reviews the anatomy of the shoulder complex. Special attention is paid to the scapula. He also describes in detail scapular biomechanics (how it moves). Muscle imbalance may occur resulting in scapular dyskinesia.

For example, injury to some other part of the shoulder can cause muscle spasm. Or it can cause reflex inhibition. Reflex inhibition is a way the shoulder has of protecting itself. It does this by keeping the muscles from contracting to limit motion. Pain may be decreased but muscle imbalance leads to scapular dyskinesia.

Surgery can be avoided with a program of stretching, strengthening, and repositioning of the scapula. The author provides a detailed discussion of each aspect of treatment.

He reminds sports medicine health care specialists to look for the cause of scapular dyskinesia above and below the shoulder joint. Ankle sprains, limited back motion, weak hip muscles, or other problems along the kinetic chain can lead to scapular dyskinesia.

The kinetic chain refers to how each part of the body works together smoothly in a sequence from head to toe. For an athlete to throw a ball, there must be a smooth transfer of force from the feet up to the head and neck. Past injuries that have not been rehabilitated fully must be addressed when working with athletes to resolve the problem of scapular dyskinesia.

Reference: 

John D. Kelly IV, MD. Identifying and Managing Scapular Problems in Overhead Athletes. In The Journal of Musculoskeletal Medicine. May 2007. Vol. 24. No. 5. Pp. 228-235.

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