Scapular dyskinesia

[PittsburghPain]

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Anybody with thoughts on the best therapy modalities for scapular dyskinesia? I know this is quite the loaded question given the primary source/sources contributing to its development varies greatly. However, figured I'd see if anyone has a preferred therapy program for the retraining aspect.

 

[Gauss]

what kind of dyskinesia? long thoracic nerve injury is a totally different problem than say impingement related dyskinesia. scapular stabilization program is what you're prescribing and it will really depend on how good of a shoulder therapist you find.

 

[PittsburghPain]

I was referring more to mechanical-induced dyskinesia such as secondary to chronic rotator cuff pathology or poor throwing mechanics. Not associated with LT or Spinal Accessory nerve pathology.
What specifics are people including in their prescriptions outside of the basic anterior chain stretching? Are people still using Blackburn exercises for scapular retraction? How often are you asking your therapist to also evaluate distal (thoracic/lumbar/hip/lower limb) kinetic chain?
Good therapist dedicated to the shoulder can be hard to find out there in some of the smaller communities. Just trying to pick brains here for ideas/philosophies.

 

[jesspt]

I was referring more to mechanical-induced dyskinesia such as secondary to chronic rotator cuff pathology or poor throwing mechanics. Not associated with LT or Spinal Accessory nerve pathology.
What specifics are people including in their prescriptions outside of the basic anterior chain stretching? Are people still using Blackburn exercises for scapular retraction? How often are you asking your therapist to also evaluate distal (thoracic/lumbar/hip/lower limb) kinetic chain?
Good therapist dedicated to the shoulder can be hard to find out there in some of the smaller communities. Just trying to pick brains here for ideas/philosophies.

From my experience, Blackburn exercises are still commonly used during the rehabilitation of these patients, as are capular stretches and weight bearing strengthening exercises. Here is a reference from Burkhart, Morgan and Kibler regarding the exam and treatment of scapular dyskinesia:

http://www.rijnlandorthopedie.nl/uploads/pdf/WerpschouderCurrConceptsBurkhart.pdf

And, it might help you to try to use the following reference when trying to find someone to rehab your patients with scapular problems. Either a sports specialist or orthopaedic physical therapy specialist would fit the bill.

http://www.abpts.org/apta/directories/abpts.aspx?navid=10737423513

 

[PittsburghPain]

JessPT thanks for the reply. I am very familiar with the Burkhart article and remember reading it during my residency (great article). Since you brought the article up, are therapists in most communities still using the "Sleeper Stretch" for capsular tightness or has that fallen out of favor?

Any newer literature anyone recommends on reviewing in regards to scapular dyskinesia rehabilitation?

From my experience, Blackburn exercises are still commonly used during the rehabilitation of these patients, as are capular stretches and weight bearing strengthening exercises. Here is a reference from Burkhart, Morgan and Kibler regarding the exam and treatment of scapular dyskinesia:

http://www.rijnlandorthopedie.nl/uploads/pdf/WerpschouderCurrConceptsBurkhart.pdf

And, it might help you to try to use the following reference when trying to find someone to rehab your patients with scapular problems. Either a sports specialist or orthopaedic physical therapy specialist would fit the bill.

http://www.abpts.org/apta/directories/abpts.aspx?navid=10737423513

 

[jesspt]

I think the sleeper stretch is still very commonly used. My preference for when my patients are into clinic is to manually stretch them into horizontal adduction while pushing the lateral border of their scapula medially.

 

[truthseeker]

I am also a PT and an ATC with experience with throwers. In my professional opinion, it is critical to look at the patient's throwing mechanics and address poor push off from the rubber (if they are a pitcher) and/or the function of the lower extremity with regard to the assistance offered during deceleration.

Activate the serratus (an upward rotator) with big magnitude sagital plane pendulum exercise. Activate the rhomboids with a "baseball lunge" (an anterior lunge done in concert with a D2 diagonal - looks and feels to the patient like throwing.) the important part is the change in direction at the bottom of the manuver. probably not clear but its hard to explain without a video.