Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review
Ratcliffe E, Pickering S, McLean S, Lewis J. Br J Sports Med. 2013 Oct 30. [Epub ahead of print]
Take Home Message: Currently, there is insufficient evidence to demonstrate that consistent patterns of scapular dyskinesis in patients with SIS exist. Rehabilitation of the scapula in patients with SIS is currently not supported by the literature.
Altered scapular orientation, termed scapular dyskinesis, is often found in conjunction with subacromial impingement syndrome (SIS). SIS is defined as shoulder pain and pathology within the subacromial space, but its etiology is not fully understood. Non-surgical treatment options often focus on restoration of normal scapular posture; however, it is unclear whether altered scapular orientation contributes to or instead compensates for this syndrome. Identification of common patterns in scapular orientation could guide treatment options for patients with SIS. Therefore, the purpose of this study was to systematically review the literature to examine whether a difference exists in scapular orientation between people without shoulder symptoms and those with SIS. The authors performed a systematic review of the literature. Of the 7445 papers identified, 18 were selected for further analysis. Two-independent reviewers assessed these studies for inclusion, data extraction and quality. Only 10 studies met the inclusionary criteria. In each of the studies, participants were recruited from numerous populations (clinics, sports teams, construction industries, and wheelchair users) and wide age ranges (17-74 years), and pain was assessed using various pain scores. Additionally, various methods were utilized to assess scapular orientation including 2D radiological measurements, 360 degree inclinometers and 3D motion and tracking devices. Findings from each study were inconsistent. Specifically, some studies reported patterns of reduced upward rotation, increased anterior tilting and medial rotation while others reported the opposite or no differences when compared to asymptomatic controls.
The authors of this study sought to identify relationships between SIS and scapular orientation; however, results of their systematic review demonstrated a lack of consistency in the methodology and results. Alterations in scapular orientation were observed in many patients with SIS; however, results were often contradictory and therefore patterns could not be identified. It is possible that differences in scapular orientation may be confounded by the multi-factorial nature of SIS. Specifically, it is possible that the increased scapular upward rotation and posterior tilting observed in some patients with SIS may be explained as a compensatory strategy to reduce pain while other patients may be unable to compensate. Additionally, it is possible that the contradictory result of decreased scapular upward rotation and increased anterior tilting observed in some patients may be the cause of the SIS, reducing subacromial space and resulting in mechanical abrasion of the subacromial tissues. In conclusion, findings from this systematic review suggest that no definitive relationship exists between scapular orientation and SIS. The authors state that rehabilitation of the scapula to restore “normal” scapular posture is currently not supported by the literature. Further research is necessary in order to establish a common pattern in scapular orientation in patients with SIS, using standardized methodology and within appropriate populations, in order to guide management of this syndrome.
Questions for Discussion: Do you think that altered scapular orientation contributes to or instead compensates for SIS? Do your patients with SIS benefit from rehabilitation of the scapula?
Written by: Katie Reuther
Reviewed by: Stephen Thomas
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Ratcliffe E, Pickering S, McLean S, & Lewis J (2013). Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. British Journal of Sports Medicine PMID: 24174615