Presence Of Scapular Dyskinesis Research Articles

The ISAKOS subclassification of Rockwood type III AC joint dislocations in a stable type A and an unstable type B is not clinically relevant.

The treatment of Rockwood type III AC joint dislocations has been debated for decades. In 2014, theInternational Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee suggested a subclassification of the injury into type A, considered stable and best treated nonsurgically, and type B, considered unstable and best treated surgically. Type B is defined by the presence of scapular dyskinesis and overriding of the clavicle to the acromion on a modified lateral radiograph. The objective of the study was to investigate if this subclassification is clinically relevant. This was a prospective cohort study. Inclusion criteria were patients aged 18-60 years with acute AC joint dislocation and a baseline Zanca radiograph with an increase in the CC distance of >25% compared to the uninjured side. All patients were treated nonsurgically with 3 months of home-based training and with the option of delayed surgical intervention. Patients were assessed at baseline and at follow-ups 6 weeks, 3 months, 6 months and 1 year after the injury. At the 6-weekfollow-up, patients were graded as stable and unstable according to the ISAKOS criteria. Outcomes were the Western Ontario Shoulder Instability Index (WOSI) and referral for surgery. At 6 weeks of follow-up,20 patients were classified as stable type A and 69 were classified as unstable type B. The ISAKOS subclassification was not clinically relevant, but patients graded as stable had statistically significantly better WOSI scores at 6 months compared to the unstable group (p = 0.03)but not at 3 months or 1 year. Nine patients (9.5%), all from the unstable group, were referred for surgery. No patients from the stable group underwent surgery (n.s). The ISAKOS subclassification of Rockwood type III in a stable type A and an unstable type B is not clinically applicable. Level II.

Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study.

Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. A total of 65 patients (72.3% females), with a mean age of 41.8years, were analyzed. At the end of 6weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5cm (P < .001); and Visual Analogue Scale at grip -2.3cm (P < .001). At the end of 6weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.

Scapular stabilization exercise training improves treatment effectiveness on shoulder pain, scapular dyskinesis, muscle strength, and function in patients with subacromial pain syndrome: A randomized controlled trial

IntroductionSubacromial pain syndrome (SPS) is a common cause of shoulder pain, and is associated with functional limitation, workdays lost, disability, and poor quality of life. PurposeOur purpose was to investigate the effects of scapular stabilization exercises in patients with SPS. MethodSixty-four patients with SPS who also exhibit observable scapular dyskinesis defined by the scapular dyskinesis test were recruited and randomized to scapular stabilization exercise training group or to control group. All participants received the same rehabilitation protocol including glenohumeral and scapular mobilization, pendulum exercises, shoulder stretching, range of motion exercises, strengthening, and proprioceptive exercises. Patients in the scapular stabilization exercise training group performed additional scapular stabilization exercises. The presence of scapular dyskinesis, shoulder pain severity, motion, muscle strength, scapular upward rotation, and shoulder disability were assessed before and after the four-week rehabilitation program. ResultsThe scapular stabilization exercise training group had better improvement in scapular dyskinesis, pain, muscle strength, and shoulder disability compared to the control group (p < 0.05). However, there was no statistically significant time-group interaction regarding shoulder motion and scapular upward rotation (p > 0.05). ConclusionsScapular stabilization exercises added to the shoulder mobilization, stretching, and strengthening are effective in improving scapular dyskinesis, reducing pain, increasing muscle strength and shoulder function in patients with SPS accompanied by scapular dyskinesis.

What factors contribute to the Scapular Assistance Test result? A classification and regression tree approach

The aim of this study was to determine predictive factors related to the Scapular Assistance Test in individuals with shoulder pain during arm elevation, and to analyze how these predictors interact in a nonlinear manner to discriminate the result of a positive and negative Scapular Assistance Test. Eighty-four individuals with shoulder pain with positive (n = 47, average age 38.4 years) and negative (n = 37, average age 37.8 years) Scapular Assistance Test completed the study. Demographic data, affected shoulder, pain duration, pain at rest, angular onset of pain, scapular dyskinesis, serratus anterior and lower trapezius muscle strength, Disabilities of Arm, Shoulder and Hand questionnaire and Pain Catastrophizing Scale were assessed in all participants. The Classification and Regression Tree analysis was used to determine which factors would predict the occurrence of a positive or negative Scapular Assistance Test and possible interactions among them. The resulting tree presented seven levels that combine the following variables: angular onset of pain, presence of scapular dyskinesis, pain catastrophizing, serratus anterior and lower trapezius muscle strength. The angular onset of pain during arm elevation was the main predictor of a positive Scapular Assistance Test selected by the Classification and Regression Tree. This study indicates that the Scapular Assistance Test result may be explained not only by biomechanical variables, but also by psychological factors. Disability of the upper limbs does not seem to contribute to the Scapular Assistance Test result.

Is Scapular Dyskinesis effective on Shoulder Strength Profiles in Asymptomatic Young Swimmers?

Background and Purpose: The aim of this study was (a) to investigate whether presence of scapular dyskinesis (SD) differs by gender in asymptomatic young swimmers and (b) to compare shoulder muscle strength between asymptomatic young swimmers with and without SD.&#x0D; Methods: Fifty-six asymptomatic young swimmers (mean age:10.35y; 22 females; 34 males) were included in the study. The presence of SD was determined visually using SD test with dichotomous outcome (yes/no). The shoulder muscle strength was assessed via handheld dynamometer. &#x0D; Results: There was statistically significant difference between swimmers with and without SD in shoulder flexion muscle strength in both females and males (respectively, p

Can the Scapular Dyskinesis Test be Associated with Throwing Related Injuries During the Course of Collegiate Baseball Seasons?

BackgroundA pattern of scapular dyskinesis on the dominant side has been demonstrated to be associated with a decrease in throwing arm conditions identified by a self-report outcome assessment in collegiate baseball pitchers during the course of a single season. However, it is unclear if symptomatic shoulders in baseball pitchers may be associated with the presence of scapular dyskinesis.PurposeTo study the relationship between the presence of scapular dyskinesis and throwing-related injury in collegiate baseball pitchers during each respective course of up to four subsequent seasons.MethodsA single Division 1 National Collegiate Athletic Association team participated in this study over a four-year-period. The scapular dyskinesis test was implemented during the preseason for baseball pitchers. Players were followed throughout each respective season to track the incidence of throwing-related upper extremity injuries.ResultsA total of 36 collegiate baseball pitchers (height: 185.3 ± 5.6 cm, weight: 88.8 ± 7.8 kg, age: 20.0 ± 1.5 years) consisting of 57 pitcher seasons were followed in this study, in which 18 pitchers remained with the team for more than one year. Twenty-seven of the 57 pitchers were classified as having scapular dyskinesis demonstrated at around 90° of shoulder flexion on the throwing side. Five injuries (13.2% of a total of 38 injuries) were diagnosed as throwing-related shoulder injuries during the course of the intercollegiate baseball seasons. Four of the five throwing-related shoulder injuries occurred in pitchers who had scapular dyskinesis on their dominant side. Consequently, the odds ratio was 5.04 for the collegiate pitchers with scapular dyskinesis on the throwing arm side associated with a throwing-related shoulder injury compared to those with no scapular dyskinesis (p = 0.16). No relationship was identified between scapular dyskinesis on the throwing arm side and throwing-related elbow injury. Eighty-one percent of the scapular dyskinesis test results were not changed on the throwing side from the previous to the following year for those 18 pitchers who were followed for more than one season, whereas 42.9% of the results remained unchanged on the non-throwing side.ConclusionThe results suggest that collegiate baseball pitchers with dominant arm scapular dyskinesis likely are at increased risk of throwing-related shoulder injury.Level of evidenceLevel 2, Prospective Cohort Study

Relationship Between Clinical Scapular Assessment and Scapula Resting Position, Shoulder Strength, and Baseball Pitching Kinematics and Kinetics.

Background:Scapular assessment is important in examining overhead athletes, but there is inconsistency in scapular clinical assessment and its relation to pathology.Purpose:To determine the relationship between clinical scapular assessment and biomechanical scapula resting position, shoulder strength, and pitching shoulder kinematics and kinetics.Study Design:Descriptive laboratory study.Methods:Two clinicians performed scapular assessments and graded the scapula as presence or absence of scapular dyskinesis. Shoulder external rotation (ER) and internal rotation (IR) strength were collected. The 3-dimensional biomechanics of the scapula resting position (upward/downward rotation, IR/ER, and anterior/posterior tilt) were assessed while participants stood at rest, and pitching kinematics (maximum shoulder ER, shoulder abduction, shoulder horizontal abduction, shoulder rotation velocity) and kinetics (maximum shoulder distraction force) were assessed when participants pitched off the portable pitching mound that was engineered to meet major league specifications.Results:A total of 33 high school baseball pitchers (age, 16.3 ± 1.2 years; height, 184.0 ± 6.9 cm; weight, 76.8 ± 20.8 kg; hand dominance: left, 9 [27%]; right, 24 [73%]; pitch velocity, 34.7 ± 2.3 m/s) participated in this study. Of them, 15 participants had scapular dyskinesis, and 18 had normal scapulothoracic rhythm. No differences were observed for upward/downward rotation or anterior/posterior tilt, shoulder ER, shoulder abduction, or shoulder distraction force, based on the presence of scapular dyskinesis. Pitchers with scapular dyskinesis demonstrated significantly greater scapular resting IR position (effect size [ES], 0.80; 95% CI, 0.06 to 1.54; P = .020), greater nondominant shoulder ER to IR strength ratio (ES, 0.49; 95% CI, –0.02 to 1.00; P = .018), and decreased shoulder rotation velocity (ES, 14.66; 95% CI: 12.06 to 17.25; P = .016). Pitchers with greater anterior tilt demonstrated greater shoulder rotation velocity (r = –0.48; P = .006).Conclusion:Pitchers with scapular dyskinesis had greater scapular IR, greater nondominant shoulder ER to IR strength ratio, and reduced shoulder rotation velocity.Clinical Relevance:Scapular assessment may be more influenced by differential IR than upward rotation or anterior tilt. Scapular dyskinesis has no competitive performance advantage among amateur athletes. Greater understanding is needed to decipher the critical threshold between beneficial and maladaptive scapular movement patterns.

Examining the link between thoracic rotation and scapular dyskinesis and shoulder pain amongst college swimmers

ObjectivesIn National Collegiate Athletic Association Division I swimmers, we examined the differences in thoracic spine rotation in swimmers with and without scapular dyskinesis and the relationship between thoracic spine rotation and shoulder pain/dysfunction according to the Kerlan-Jobe Orthopaedic Clinic (KJOC) score. DesignCross-sectional. SettingLaboratory-based. Participants34 NCAA Division I swimmers (13 males, 21 females). Main outcome measuresSelf-reported upper extremity function and pain assessed with the KJOC questionnaire, thoracic spine range of motion, presence of scapular dyskinesis. ResultsDyskinesis was present in 15 of 34 (44%) subjects. Thoracic rotation averaged 136.7° and KJOC averaged 87.7 with no differences between swimmers with or without dyskinesis. We observed no correlation between KJOC-identified shoulder pain/dysfunction and thoracic rotation. ConclusionsIn our cohort of NCAA Division 1 swimmers, no differences were found between swimmers with or without scapular dyskinesis and extent of thoracic rotation. We found no correlation between thoracic rotation and the amount of self-reported pain and dysfunction experienced in the upper extremity. The presence of scapular dyskinesis in nearly half of our subjects indicates that swimmers need to be assessed for this abnormality. If observed, rehabilitation should address the dyskinesis and improve thoracic rotation in an attempt to alleviate further upper extremity pain and dysfunction.

Presença de retroversão umeral e discinesia escapular em praticantes de tiro de laço

ObjectiveThe objective of the present study was to evaluate the presence of humeral retroversion and scapular dyskinesis in these practitioners. MethodsThis cross‐sectional study enrolled 129 subjects. The state of dyskinesis, muscle strength, range of motion, level of functionality and shoulder pain were evaluated. ResultsThe external rotation was higher (p=0,005) and minor internal rotation on the dominant shoulder (p=0,0001). The total movement of the dominant shoulder was lower, compared to the non‐dominant (p=0.0001). The presence of Scapular dyskinesis was 32,6%, predominantly type II dyskinesis (50%). The Spadi score was significantly higher in those with pain symptoms (p<0.05). ConclusionPeople who practice tie‐down roping showed humeral retroversion on the dominant shoulder and higher prevalence of scapular dyskinesis.

The Effect of Electrical Stimulation Cueing in a Competitive Powerlifter with Shoulder Pain and Scapular Dyskinesis: A Case Study

Background: Shoulder conditions are a common musculoskeletal complaint. The presence of scapular dyskinesis has been shown to result in 43% increase in shoulder pain in athletes. It is known that peripheral ES changes muscle behavior. There are no studies that examine exercise with triggered ES to the lower trapezius, to address shoulder pain and scapular dyskinesis. Methods: The purpose of this case study was to demonstrate that specific parameters with triggered ES, combined with 3 exercises, would result in meaningful improvement in shoulder function and pain in a 22-year-old powerlifter with chronic shoulder pain and scapular dyskinesis. The patient received 6 treatments of trigger switch cued ES and exercise plus four manual therapy sessions. A biphasic-pulsatile current was used. The frequency and pulsewidth were 25 pps and 250 usec, respectively. The intensity was comfortable and produced scapular retraction. Results: Improvements were noted in all outcomes. Numeric Pain Rating Scale was decreased to 1/10. Left shoulder passive range of motion was returned to 100%. The Quick Dash Disability score improved from 38.6% to 2.27%. The Quick Dash Work Module score improved from 6.6 to 0, the Quick Dash Sport Module score improved from 37.5 to 0. The Patient Specific Functional Scale score improved from 3.7 to 8.3. Thoracic spine to scapula distance differences occurred at the following shoulder abduction angles: -0.7 cm at 0, -0.1 cm at 45, +0.4 cm at 90, and -0.5 cm at 120. Conclusion: Trigger switch ES and 3 exercises, plus traditional manual therapy, resulted in improvement in all self-report outcome measures and a change in thoracic spine to scapula distance in a patient with shoulder pain and scapular dyskinesis who had failed to improve by traditional physical therapy.

The Effect of Shoulder Muscle Fatigue on Acromiohumeral Distance and Scapular Dyskinesis in Women With Generalized Joint Hypermobility.

Muscle fatigue is considered to be one cause of shoulder pain, and subjects with generalized joint hypermobility (GJH) are affected more by shoulder pain. The purpose of this study was to examine the effects of muscle fatigue on acromiohumeral distance (AHD) and scapular dyskinesis in women with GJH. Thirty-six asymptomatic participants were assigned to either a GJH (n = 20) or control group (n = 16) using the Beighton scale. Before and after elevation fatigue trials, AHD was measured with ultrasonography at rest and when the arm was in 90° active elevation. A scapular dyskinesis test was used to visually observe alterations in scapular movement. Our results showed that in both groups, the fatigue reduced AHD in the 90° elevation position and increased the presence of scapular dyskinesis; however, no differences were found between the two groups. Although GJH has been identified as a factor for developing musculoskeletal disorders, generalized joint hypermobility did not result in changes to scapular dyskinesis or AHD, even after an elevation fatigue task. More studies are needed to evaluate the effects of muscle fatigue in subjects with GJH and a history of shoulder instability.

The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome

Study DesignProspective cohort. IntroductionAssessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. Purpose of the StudyTo evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. MethodsForty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. ResultsSDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. ConclusionsIntrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. Level of Evidence1b.

Traitement des disjonctions acromioclaviculaires sévères aiguës : la stabilisation arthroscopique non rigide procure une meilleure qualité de vie que l’ostéosynthèse par plaque crochet

IntroductionTreatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal-hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related injuries. Arthroscopy-assisted procedures compared to open-metal-hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III–V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24months or more after their shoulder injury. Patients and methodsA retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. ResultsThirty-one patients were included: 20 arthroscopy group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25–52] years old for the ARTH group and 41 [19–55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). ConclusionPatients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. Level of evidenceLevel IV. Therapeutic; retrospective comparative study.

Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF

IntroductionTreatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III–V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. Patients and methodsA retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. ResultsThirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25–52] year-old for the ARTH group and 41 [19–55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). ConclusionPatients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. Level of evidenceLevel IV therapeutic; retrospective comparative study.

Acute unstable acromioclavicular joint injuries: quality of life comparison between patients managed operatively with a coracoclavicular suspension device arthroscopically placed versus patients managed non-operatively

The main aim was to compare the quality of life (QoL) of patients with acute unstable acromioclavicular joint (ACJ) injuries (grade IIIB-V according to the ISAKOS diversification of the Rockwood classification), managed operatively with a coracoclavicular suspension device arthroscopically placed versus the QoL of patients managed non-operatively, 24 months or more after shoulder injury. The secondary aims were to describe the prevalence of scapular dyskinesis in each group of treatment and to assess its relation to the magnitude of shoulder pain. Patients with acute unstable ACJ injuries managed operatively or non-operatively, between 2008 and 2012 were included. Grade IIIA and IIIB injuries were differentiated. Grade IIIA injuries were excluded. The QoL was evaluated by means of the Health Survey questionnaire (SF36), the visual analogue scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed at the initial visit post-injury and at the last follow-up visit. The difference between values registered at these different moments was calculated. The Constant score, the global satisfaction (scale from 0 to 10), and the presence of scapular dyskinesis were assessed at the last follow-up visit. The VAS was stratified according to the presence or absence of scapular dyskinesis. Comparison between groups was performed. In the SURG-group, the development of secondary displacements was radiologically evaluated. Forty-one patients were included: 21 CONS-group (4 Rockwood IIIB and 17 V) and 20 SURG-group (3 Rockwood IIIB, 3 IV, and 14 V). The mean age was 37 [19–55] years, and the mean follow-up was 36 [24–90] months. The difference between the questionnaires assessed at the last follow-up visit and at the initial visit post-injury was: (1) physical SF36 score (CONS-group 18.6 ± 6.1 and SURG-group 28.1 ± 6.9, p = 0.001); (2) mental SF36 score (CONS-group 10.8 ± 11.2 and SURG-group 10.6 ± 6.8, p = 0.960); (3) VAS (CONS-group −7.3 ± 1.7 and SURG-group −7.7 ± 1.2, p = 0.412); (4) DASH questionnaire (CONS-group −55.7 ± 9.8 and SURG-group −77.4 ± 9,5, p = 0.020). The mean Constant score assessed at the last follow-up visit was (CONS-group 91.1 ± 7.4 and SURG-group 95.3 ± 2.5, p = 0.020). The mean global satisfaction registered at the last follow-up visit was (CONS-group 8.5 ± 1.7 and SURG-group 8.9 ± 0.9, p = 0.371). There was evidence of scapular dyskinesis in 52.4 % (11/21) of the patients of the CONS-group and in 15 % (3/20) of the patients of the SURG-group (p = 0.030). The mean VAS registered at the last follow-up visit in the group of patients that developed scapular dyskinesis was 2 ± 0.96 and in the group of patients with normal scapular motion 0.3 ± 0.47 (p = 0.000). In the SURG-group, anatomic reduction of the ACJ was finally achieved in 60 % (12/20) of the patients; vertical subluxations were observed in 20 % (4/20); and complete dislocations were observed in 20 % (4/20). Patients with acute unstable ACJ injuries managed operatively with a coracoclavicular suspension device arthroscopically placed have a better quality of life in terms of the physical SF36, DASH, and Constant score, than patients managed non-operatively, 24 months or more after shoulder injury. Although the global satisfaction is not different between groups, the prevalence of scapular dyskinesis is greater in the group of patients managed non-operatively and the scapular dyskinesis is significantly associated to a higher pain. Level of evidence: level III, retrospective cohort study

Clinical Assessment of Scapula and Hip Joint Function in Preadolescent and Adolescent Baseball Players

Background: Proper scapulothoracic and hip mechanics are essential aspects of the throwing kinetic chain. Little is known regarding these entities in preadolescent and adolescent baseball players. Hypothesis: Scapular malposition and dyskinesis as well as hip dysfunction are highly prevalent in preadolescent and adolescent baseball players and may be identified by simple clinical testing. Study Design: Descriptive laboratory study. Methods: A total of 112 baseball players aged 7 to 18 years were recruited from local Little Leagues, traveling teams, and high schools. Participants were divided into 2 groups: preadolescents (players aged 7-12 years) and adolescents (players aged 13-18 years). Scapular symmetry was tested with the yes/no method of Kibler and by measuring forward shoulder posture via the “coracoid distance.” Hip abductor strength was measured by use of a handheld digital dynamometer. Functional gluteal and core strength was assessed by video analysis of the subjects performing the single-legged squat test. Hip range of motion was measured in the prone position by use of a handheld goniometer. Results: Compared with the preadolescent group, the adolescent group had a significantly higher prevalence of scapular dyskinesis in the throwing shoulder (50% vs 25.9%, P = .011). The adolescents had significantly higher normalized hip abduction strength in both the stride (17.41 vs 12.62 N/kg, P < .001) and stance (17.82 vs 12.61 N/kg, P < .001) legs. The preadolescent group was unable to perform the single-legged squat test correctly in either the stance (0% preadolescent vs 13% adolescent, P = .0127) or stride (0% preadolescent vs 9.3% adolescent, P = .0567) leg. The mean coracoid distance was elevated in the dominant (throwing) shoulder after controlling for scapular dyskinesis (P < .0001). Presence of scapular dyskinesis was associated with a higher mean coracoid distance (P = .0067). Conclusion: There was a high prevalence of dominant shoulder scapular dyskinesis in the adolescent compared with the preadolescent group, as well as universally poor single-legged squat test performance. The mean coracoid distance was higher in the dominant or throwing side compared with the nondominant side independent of scapular dyskinesis. Presence of scapular dyskinesis was associated with higher mean coracoid distance. Clinical Relevance: Identification of players thought to be at increased risk for throwing injuries and initiation of targeted rehabilitation programs may decrease injury rates in preadolescent and adolescent baseball players.

Scapular Displacement and Its relationship to Shoulder Internal and External Rotator Muscle Function

Alterations in scapular position and movement often referred to scapular dyskinesis are hypothesized to bear a direct relationship to scapular stability and the generation of muscular force production. However, there is a lack of data regarding the influence of the scapular malposition to the shoulder muscle function. PURPOSE: To examine the scapular displacement during the sitting hand press up test and its relationship to shoulder internal and external rotator muscle function in Division III baseball players. METHODS: Total fifty-one Division III overhead athletes [12 female volleyball players (18.5±0.67 yrs, 70.79±9.29 kg, 173.25±6.65 cm) and 39 male baseball players (19.7±1.3 yrs, 83.45±12.83 kg, 180.47±7.42 cm)] participated in the study. Scapular dyskinesis during the rest position and the sitting hand press up test was measured using the Hong's tool. Concentric internal and external rotation peak torques and time to peak torques were measured on the dominant arm at 60 degree/sec. Subjects were tested in the seated position with the shoulder abducted to 90° and the elbow flexed to 90°. The cutoff point for those with scapular kinesis and those not exhibiting winging is 1cm. RESULTS: The athletes with scapular posterior displacement (SPD)> 1cm exhibited significantly delayed time to peak torques (msec) in both internal and external rotation of shoulder (893.18±386.61 and 623.63±393.67 msec) compared to the athletes with SPD< 1cm (482.75±257.12 and 339.65±231.55 msec) (p<0.05). There were no differences in internal and external rotation peak torques between groups. CONCLUSION: The results of the study indicated that overhead athletes with scapular dyskinesis show delayed time to peak torques in shoulder internal and external rotation. The findings support the theory that the presence of scapular dyskinesis may be related to the delayed shoulder muscular force production.

A Clinical Method for Identifying Scapular Dyskinesis, Part 2: Validity

Although clinical methods for detecting scapular dyskinesis have been described, evidence supporting the validity of these methods is lacking. To determine the validity of the scapular dyskinesis test, a visually based method of identifying abnormal scapular motion. A secondary purpose was to explore the relationship between scapular dyskinesis and shoulder symptoms. Validation study comparing 3-dimensional measures of scapular motion among participants clinically judged as having either normal motion or scapular dyskinesis. University athletic training facilities. A sample of 142 collegiate athletes (National Collegiate Athletic Association Division I and Division III) participating in sports requiring overhead use of the arm was rated, and 66 of these underwent 3-dimensional testing. Volunteers were viewed by 2 raters while performing weighted shoulder flexion and abduction. The right and left sides were rated independently as normal, subtle dyskinesis, or obvious dyskinesis using the scapular dyskinesis test. Symptoms were assessed using the Penn Shoulder Score. Athletes judged as having either normal motion or obvious dyskinesis underwent 3-dimensional electromagnetic kinematic testing while performing the same movements. The kinematic data from both groups were compared via multifactor analysis of variance with post hoc testing using the least significant difference procedure. The relationship between symptoms and scapular dyskinesis was evaluated by odds ratios. Differences were found between the normal and obvious dyskinesis groups. Participants with obvious dyskinesis showed less scapular upward rotation (P < .001), less clavicular elevation (P < .001), and greater clavicular protraction (P = .044). The presence of shoulder symptoms was not different between the normal and obvious dyskinesis volunteers (odds ratio = 0.79, 95% confidence interval = 0.33, 1.89). Shoulders visually judged as having dyskinesis showed distinct alterations in 3-dimensional scapular motion. However, the presence of scapular dyskinesis was not related to shoulder symptoms in athletes engaged in overhead sports.