Upload
edwin-jefferson
View
215
Download
0
Embed Size (px)
Citation preview
W.Kibler , John McMullen
J Am Acad Orthop Surg 2003
A JOURNAL ARTICLE REVIEW
ARTICLE INCLUDES
Normal scapular functionScapular DyskinesisMethods of classificationEvaluation techniques
SCAPULAR DYSKINESISIt is defined as observable alterations in the
position of the scapula & the patterns of scapular motion in relation to thoracic cage
The term does not suggest etiology or define patterns that correlate with specific shoulder injuries
Classification of scapular dyskinesis patterns and positions can help to determine treatment
Factors responsibleBony posture or injurycontractures & other flexibility problemsAlteration in muscle function
SCAPULAR EVALUATION SHOULD INCLUDEPostural evaluationResting Scapular EvaluationDynamic Evaluation of scapular motionCorrective measures
SCAPULAR EVAL SHOULD BE DONE FROM POSTERIOR ASPECT
FIRSTLY SCAPULA SHOULD BE EVALUATED IN STATIC POSITION AS IN LONG-STANDING SCAPULAR DYSKINESIS,RESTING WINGING MAY BE SEEN
DYNAMIC EVALUATIONShould be examined in both elevating &
lowering phase of motionMuscle weakness & mild dyskinesis is
commonly seen in lowering phase of arm movement
These commonly present as hitch or jump in otherwise smooth motion of scapula and may be more noticeable with several repetitions
TYPE I PROMINENCE OF INFERIOR MEDIAL SCAPULAR BORDERABNORMAL ROTATION AROUND TRANSVERSE AXISINDICATES WEAKNESS OF LOWER TRAP, LAT DORSI, SERR ANTOR TIGHT PECT MINOR,MAJOR
TYPE IICLASSIC WINGING
PROMINENCE OF ENTIRE MEDIAL SCAPULAR BORDERABNORMALROTATION AROUND VERTICAL AXISINDICATES WEAKNESS OF SERR ANT,RHOMBOIDS,ALL FIBERS OF TRAP
TYPE IIIPROMINENCE OF SUPERIOR MEDIAL SCAPULAR BORDER WITH SUPEROR TRANSLATION OF ENTIRE SCAPULAINDICATES OVERACTIVITY OF LEVATOR SCAPULAE & IMBALANCE OF UPPER & LOWER TRAP FORCE COUPLE
TESTS PERFORMED TO INDICATE WEAKNESS OF SCAPULAR MUSCLES
Isometric scapular pinch testWall push- ups Lateral scapular slide testScapular assistance testScapular retraction test
ISOMETRIC SCAPULAR PINCH TEST
Scapula can be normally held in retraction with isometric pinch for 15 to20 seconds without burning pain or muscle weakness
Scapular ms weakness may manifest as burning pain in less than 15 sec.
WALL PUSH - UPS
Wall push ups are effective for evaluating serratus anterior strength
Abnormalities may be noted with 5 to 10 Wall push –ups
LATERAL SCAPULAR SLIDE TESTInferior – medial angle of scapula is palpated &
marked on both the sidesThe reference point on the spine is nearest
spinous process,which is markedDistance is measured on both the sides in three
different positions,- At resting position With hands on hips, with fingers anterior &thumb
posterior With the arms at 90 degrees with internal rotation
A 1.5 cm asymmetry is the threshold for abnormality
LATERAL SCAPULAR SLIDE TEST
SCAPULAR ASSISTANCE TESTDuring abduction or
forward elevation, assistance is provided by manually stabilizing the scapula and rotating inferior border of scapula as the arm moves
This proc simulates force couple activity of serratus ant and lower trap
Elimination or modification of symptoms indicate these muscles should be major focus in rehab.
SCAPULAR RETRACTION TESTThe examiner
stabilizes the medial scapular border as the arm is elevated or externallyrotated.
Relief of impingement symptoms is a positive test
Guidelines for Integrated Rehabilitation of Scapular Dyskinesis
Exercises Weeks (estimate)Scapular MotionThoracic posture 1-3Trunk flexion/extension/rotation 1-3Lower abdominal/hip extensor 1-5
Muscular FlexibilityMassage 1, 2Modalities (eg, ultrasound, electronic stimulation) 1-3Stretching (eg, active-assisted, passive, PNF) 1-8Corner stretches (pectoralis minor) 1-3Towel roll stretches (pectoralis minor) 1-3Levator scapulae stretches 1-3“Sleeper” position stretches (shoulder ER) 1-3
Closed Kinetic Chain Co-contraction Exercises
Weight-shifting 1, 2Balance board 1, 2Scapular clock 1, 2Rhythmic ball stabilization 2Weight-bearing isometric extension 1, 2Wall push-up 2Table push-up 3-5Modified to prone push-up 5-8
Axially Loaded AROM ExerciseScaption slide 2-5Flexion slide 2-5Abduction glide 3-5Diagonal slides 2-6
Integrated Open Kinetic Chain Exercises
Scapular motion exercices plus arm elevation 3-8Unilateral/bilateral tubing pulls with trunk motion 4-8Modified lawn mower series 3-6Dumbbell punches with stride(progressive height and resistance) 6-8Lunge series with dumbbell reaches 5-8
Plyometric Sport-Specific Exercises
Medicine ball toss and catch 6-10Reciprocal tubing plyometrics 6-10
PRESENTATION ACKNOWLEDGEMENT:
DR. PALLAVI SHIVALKARASSOCIATE PROFESSOR,
DR. D .Y PATIL COLLGE OF PHYSIOTHERAPY
NERUL, NAVI MUMBAI
THANK YOU MADAM…….DR. AJIN JAYAN THOMAS