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

Related Posts:

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