When a patient seeks care for shoulder pain, they usually point to the ball and socket glenohumeral joint as the source of their problem. However, a contributing cause of the patient’s shoulder pain and disability may actually be the scapula or shoulder blade and if scapular dyskinesis is present and untreated, the patient may not experience a satisfactory outcome.
As with other joints in the body, the greater the range of motion, the less stable the joint and the more susceptible it is to injury. The glenohumeral joint allows the upper extremity to move in several directions. The scapula acts to stabilize the shoulder to prevent it from moving too far into the extreme ends of its range of motion, which could compromise the integrity of the joint and lead to injury. However, if the scapula rests in an abnormal position or if its movement is restricted, it cannot fulfill this function and the chance for a shoulder disorder increases. Conditions that can occur in the presence of scapular dyskinesis include rotator cuff tears, glenohumeral joint instability, impingement syndrome, and labral tears.
During an examination, a doctor of chiropractic will evaluate scapular position at rest (arms hanging at the sides) as well as during shoulder forward flexion, abduction (motion away from the body), and rotational movements on both the right and left side of the body. The chiropractor will also view the scapula from the side to look for excessive scapular lifting from the thorax during movement.
If scapular dyskinesis is confirmed, the goal of treatment will be to restore the scapular position and dynamics, which includes scapular retractions, posterior tilt, and external rotation. This can be accomplished via a combination of manual therapies performed in the office and at-home exercises focused on stretching and stabilization that may involve active or passive movements, as well as resistance bands, hand weights, or just body weight. The specific exercises depend on the examination findings, so each patient’s exercise recommendations may differ.
Another interesting finding regarding scapular dyskinesis is that it doesn’t just affect the shoulder. In recent years, several studies have established a link between abnormal resting of the scapular and neck pain, especially in office workers with neck pain. One study published in 2023 found that 90 of 99 office workers with neck and mid-back pain had scapular dyskinesis. Another 2023 study found that patients with both neck pain and scapular dyskinesis experienced improvements in neck pain and cervical range of motion after the application of treatment to correct scapula positioning. If you have shoulder pain (or even neck pain) and your doctor of chiropractic starts evaluating your shoulder blade, now you know why this is the case.
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