Evaluation and Management of Scapular Dyskinesis in Overhead Athletes

Abstract

Purpose of review: This review will outline scapular function in throwing, discuss scapular dyskinesis as an impairment of function that can be associated with throwing injuries and altered performance, and present an algorithm that encompasses guidelines for evaluation and can serve as a basis for treatment.

Recent findings: Optimal scapular function is integral to optimal shoulder function. Multiple roles of the scapula in arm function and throwing have been identified while scapular dysfunction continues to be associated with various shoulder pathologies. Although scapular motion alterations may be common in overhead athletes, various reports have shown that identification and management of the alterations can result in improved rehabilitation and performance outcomes. Baseball throwing occurs as the result of integrated, multisegmented, sequential joint motion, and muscle activation within the kinetic chain. The scapula is a key component link within the chain through its function to maximize the scapulohumeral rhythm and efficient throwing mechanics. Evaluation and management beginning with the scapula can produce improved outcomes related to shoulder pathology in overhead athletes.

Keywords: Kinetic chain; Overhead athlete; Scapula; Scapular dyskinesis.

Conflict of interest statement

W. Ben Kibler and Aaron Sciascia receive royalties from Springer Publishing for co-editing 2 textbooks.

Figures

Fig. 1

Diagnostic algorithm

Fig. 2

Decision-making process based on algorithm findings

Fig. 3

Example of scapular dyskinesis showing medial border and inferior angle prominence

Fig. 4

Scapular assistance test

Fig. 5

Scapular retraction test. Muscle testing without (a) and with (b) scapular retraction

Fig. 6

Conscious correction of the scapula requires the patient to actively position the scapulae from a relaxed position (a) to a retracted position (b) prior to moving the arm

Fig. 7

Low row exercise: the patient is positioned standing with the hand of the involved arm against the side of a firm surface and legs slightly flexed (a). The patient should be instructed to extend the hips and trunk to facilitate scapular retraction and hold the contraction for 5 s (b)

Fig. 8

Lawnmower exercise: the lawnmower begins with the hips and trunk flexed and the arm slightly forward elevated (a). The patient is instructed to extend the hips and trunk, followed by rotation of the trunk to facilitate scapular retraction (b)

Fig. 9

Fencing: this maneuver begins in a standing position with the patient grasping resistance bands or tubing (a). It utilizes multiple kinetic chain segments to enhance proper muscle scapular muscle activation through activation of the legs, trunk, scapula, and arm (b)

Fig. 10

Reverse throw: the patient begins with the trunk and hip flexed and standing on a single leg (a) and then actively extends the trunk and hip in order to bring the arm into a position of 90° abduction and 90° of elbow flexion

Fig. 11

Power position: the athlete is positioned standing with dominant arm in 90/90 position and forearm pronated (a). The athlete is instructed to rotate the trunk without moving the feet while maintaining the 90/90 position of the arm (b). The forearm should be allowed to supinate to imitate the act of the overhead throwing