Scapular dyskinesis guidelines

Abnormal movement of the shoulder blade (scapula) is known as scapular dyskinesis. This occurs in a variety of shoulder problems. It is an important sign of an underlying shoulder disorder and a guide to shoulder rehabilitation.

Based on PhysioPedia, intervention is aimed at reducing posterior capsule and pectoralis minor restriction and restoring periscapular mm balance through exercises promoting early and increased serratus anterior, lower, and middle trapezius activation while minimizing upper trapezius activity.

• Manual gr 4 mobilization to reduce posterior capsule tension, cross-body stretch.
• Manual stretching and soft tissue mobilization to decrease pec minor tension (cadaveric studies imply that a position of 150 degrees elevation with 30 degrees scapular retraction is optimal).
• Exercises of sidelying forward flexion, external rotation, prone extension, and prone horizontal abduction to strengthen middle and lower trapezius over upper trapezius.
• Quadruped and variable push-up positions to activate serratus anterior.

Here is a very nice guideline for treating scapular dyskinesis, offered by the Beth Israel Deaconess Center (a Harvard Medical School teaching hospital).

Scapulohumeral rhythm

In the healthy shoulder, a natural kinematics rhythm/timing exists between glenohumeral ABD and scapulothoracic lateral rotation. After 30 degrees of abduction this rhythm is 2:1, meaning that for each 3 degrees of abduction, 2 degrees occur in the glenohumeral joint and 1 degree occurs in the scapulothoracic joint.

This very nice video and article by Physio-Pedia makes it very clear.

Shoulder.co.uk

Len Funk established ShoulderDoc.co.uk in 2002. Since then it has become the most popular Shoulder & Elbow information website on the internet, receiving over 150,000 hits per day!.

ShoulderDoc  started off as a simple site to provide our own patients with information and guidance that was not easily available elsewhere. We have tried to make the site as user-friendly as possible and content is added almost daily.

All articles added to the website including medical content are written by medical professionals and peer-reviewed by Prof. Lennard Funk. Wherever possible the reference sources are mentioned and hyper-linked. Sources for reference material include medical textbooks, clinical and scientific journals and our own clinical audits.

Our mission is:

• To be the one of the best resources of shoulder and elbow information.
• To educate and partner our patients in making decisions at every stage.
• To ensure that our clinical practice is of  the highest integrity and evidence based.
• To promote and provide teaching, research and innovation.

Clinical practice guidelines for the management of rotator cuff syndrome in the workplace

The University of New South Wales Rural Clinical School, Port Macquarie has developed guidelines for the clinical management of rotator cuff syndrome in the workplace. Shoulder pain is a common musculoskeletal presentation in primary care practice – both degenerative and acute. As such, it provides a challenge to all involved in prevention and treatment, from patients to clinicians to employers. The primary objective of these guidelines is to provide recommendations, based on current evidence, which will hopefully improve clinical outcomes for workers, employers and health care providers.

Shoulder disclocation

Anterior (forward)

Anterior dislocations are usually caused by a direct blow to or fall on an outstretched arm. The patient typically appears holding their arm externally rotated and slightly abducted.

Posterior (backward)

Posterior dislocations are occasionally due to electric shock or seizure and may be caused by strength imbalance of the rotator cuff muscles. Patients typically present holding their arm internally rotated and adducted, and exhibiting flattening of the anterior shoulder and a prominent coracoid process.

Inferior (downward)

Inferior dislocation is the least likely form, occurring in less than 1% of all shoulder dislocation cases. This condition is also called luxatio erecta because the arm appears to be permanently held upward or behind the head. It is caused by a hyper abduction of the arm that forces the humeral head against the acromion.

Sleeper stretch for the posterior glenohumeral capsule

When I first learned about the sleeper stretch technique for the posterior glenohumeral joint I asked myself "why would anyone want to put so much stretch on a body structure that is so thin and sensitive, since we know that the posterior part of the glenohumeral joint lacks the ligaments that are at the anterior part of the capsule?". Then I found out that I am not the only one that has the same doubts about this technique. These 3 very interesting articles at Mike Reinold.com worth reading:

The Correct Way to Perform the Sleeper Stretch

The sleeper stretch is one of those exercises that unfortunately gets abused.  As I have said, I don’t really like the sleeper stretch and I do not use it often – go back and read why I don’t use the sleeper stretch.  The stretch is probably overused and often times used used so aggressively that it may actually be doing more harm than benefit.

But I do see the need for the sleeper stretch for certain individuals.  Just like everything else, there is a time and a place to use it, but when something is very popular, it probably gets overused.  Plus, the sleeper stretch has been shown to be effective in restoring posterior shoulder tightness in overhead athletes.  So there is definitely some validity to it’s use, especially if done safely, but more on this below.

Read more

3 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either

Ah, the sleeper stretch.  Pretty popular right now, huh?  Seems like a ton of people are preaching the value of the sleeper stretch and why everyone needs to use it.  It’s so popular now that physicians are asking for it specifically.

I don’t like the sleeper stretch and I rarely use.

There, I said it, I felt like I really had the get that off my chest!  Every meeting I go to I see more and more people talking like the sleeper stretch is the next great king of all exercises.  Then I get up there and say I don’t use it and everyone looks at me like I have two heads!  Call me crazy, but I think we probably shouldn’t be using as much as we do.

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Alternatives to the Sleeper Stretch that May Actually Work Better

It is no secret that I am not a huge fan of the sleeper stretch, I have written about why I don’t use the sleeper stretch that often in the past.  While I do realize that there is a need for it at times if you know how to perform the sleeper stretch correctly, I also think there are alternatives to the sleeper stretch that may be safer and even more effective.

To begin, let me ask the question – what is it we are trying to achieve by performing the sleeper stretch?  It is probably to work on shoulder internal rotation or cross body horizontal adduction mobility (we’ll refer to the later as posterior shoulder mobility).  So let’s explore what else we can do to work on those areas.

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Assessment & treatment guidelines_1

Physiotherapy assessment and treatment in Physical Therapy education is something that you will start doing from day 1.

I believe that there is only one way to be good in that - by organizing all this information in nice documents and have them in your portfolio to access them anytime.

Here is a small file I have created with assessment and treatment guidelines for the following cases:

Osteoarthritis of the hip

Knee trauma

Acute ankle sprain

Thoracic outlet syndrome

Olecranon fracture

Carpal tunnel syndrome

Low back pain (non-specific, sub-acute phase)

Shoulder pain

Tennis elbow

Colles fracture