Shoulder Health Starts With the Scapula!

The shoulder is the most mobile ball and socket joint in the body. It is composed of the humerus (the ball) and the scapula (the socket).  When you first begin to think about the source of your shoulder pain, the most common concern is for your rotator cuff.  However, the scapula, also known as the shoulder blade, plays a major role in your shoulder movement and can be a significant source of shoulder related pain. 

Shoulder health starts with the scapula moving uniformly and freely.  The scapula relies on 17 muscles to guide its movement and anchor stability, and for normal shoulder motion to occur the scapula has to be in proper position.  

A muscle strain in the shoulder or back can lead to compensation of other muscles altering the scapular movement pattern. Or course, any direct trauma or other shoulder injuries can lead to this dysfunction.

There are multiple reasons the scapula can develop dysfuncion in its proper movement pattern. Sports related examples are repetitive overhead activites, including tennis, volleyball, throwing, and weight lifting.

Cameron Hunt Reyes, PA-C

Physician Assistant to Dr. Suzanne Elton

SICK Scapula stands for:

• Scapular Malposition
• Inferior Medial Border Prominence
• Coracoid Pain and Malposition
• and DysKinesis of Scapular Movement

Shoulder Symptoms To Look For?

Signs or symptoms of scapular dyskinesia can be obvious to a clinician- the affected shoulder may appear to be lower than the healthy shoulder, or the scapula may protrude medially.  Other symptoms may only be noted on exam or with movement- if the shoulder “stutters” and does not glide through a full range of motion. 

You might even feel vague persistent scapular pain, or even anterior pain just above the chest muscles.  The clinician will evaluate the shoulder with a physical exam. Without trauma the x-ray would most likely be normal.

There are three main scapular movement patterns that are evaluated:

Treatment Options for the Shoulder?

The treatment for scapular dyskinesia includes trigger point injections, NSAIDs and the mainstay is physical therapy, unless it is secondary to an injury requiring surgery.  The physical therapy is focused on correcting the movement pattern dysfunction, allowing the kinetic chain to resume its normal muscular pattern.

When one muscle is under utilized, it will begin to weaken and as a result become less responsive.  Other muscles, an example being the trapezius muscle, will attempt to compensate for the weakness, this can lead to an improper functioning muscle, resulting in pain.  Therapy will focus on training the weak muscles to activate, while working on soft tissue modalities to ease the current tension in the overactive muscle. Therapists will work off protocols for core strengthening, in addition to strengthening of the serratus anterior, trapezius, scapular stabilizers, and the rotator cuff muscles.The ultimate goal is for the musculature to work as a unit again.

The duration of therapy treatment can easily be 6 weeks, and much longer for at home exercises.  One will most likely have to make adjustments to help prevent the dysfunctional pattern from reoccuring.  This may entail changing the ergonomic set up for someone who sits at a desk most of the day, or developing a new warm up for one’s sport to improve muscle activation.

Cameron Hunt Reyes, PA-C

Physician Assistant to Suzanne G. Elton, MD

Orthopedics has developed as a prime interest of mine after seeing patients suffer with joint ailments, develop depression because they can no longer golf, ski, walk their dogs, or chase their children. A combination of joint injections, physical therapy and or surgery changes their lives. As fitness is a mainstay in my life, I value the importance of normal mobility to facilitate a high quality of life.

References

https://ww.sportsandortho.com/minneapolis/scapular-dyskineis-sick-scapula.htm

https://www.orthobullets.com/sports/3134/scapulothoracic-dyskinesis