Scapular Dyskinesis increases the risk of future shoulder
pain by 43% in asymptomatic athletes: a systematic review and meta-analysis
pain by 43% in asymptomatic athletes: a systematic review and meta-analysis
Hickey
D, Solvig V, Cavalheri V, Harrold M, Mckenna L . Br J Sport Med. 2017; ahead of print.
D, Solvig V, Cavalheri V, Harrold M, Mckenna L . Br J Sport Med. 2017; ahead of print.
Take Home Message:
Athletes with scapular dyskinesis have a 43% greater risk of developing
shoulder pain compared with athletes without scapular dyskinesis.
Athletes with scapular dyskinesis have a 43% greater risk of developing
shoulder pain compared with athletes without scapular dyskinesis.
One
potential risk for shoulder pain is scapular dyskinesis, (altered position and/or
motion of the scapula). Scapula dyskinesis is thought to place abnormal forces
and disrupt the overall function of the glenohumeral joint, thereby increasing
the risk of shoulder pain and impairments. Interesting scapular dyskinesis is
often observed in both symptomatic and asymptomatic athletes. Therefore, it
remains unclear whether the presence of scapular dyskinesis increases the risk
of developing shoulder pain in asymptomatic athletes. To help investigate this
question the authors conducted a systematic review to identify whether the
presence of scapular dyskinesis in asymptomatic athletes increase the risk of
developing future shoulder pain. Following PRIMSA guidelines, the authors performed the search in 6 databases: Cochran Library, EMBASE, PubMed, CINAHL, SPORTDiscus. Inclusion criteria
comprised prospective studies within an athletic population that identified
whether these athletes were assessed for scapular dyskinesis, pain free at
baseline, and were assessed for pain at follow-up. The authors identified 5
articles that met the inclusionary criteria. Quality of these articles were
assessed using a modified version of the Downs and Black
guidelines,
where the max score was 20 instead of 30. Based on this modified scale the
average score was 16/20 (81%). Out of 419 athletes, 160 (38%) presented with
asymptomatic scapular dyskinesis. Over a period of 9 to 24 months 56 (35%) athletes
with scapular dyskinesis developed shoulder pain. In comparison 65 of the 259
athletes (25%) without scapular dyskinesis developed shoulder pain. The authors
found that the presences of scapular dyskinesis at baseline was indicative of a
43% increased risk of shoulder pain over a 9 to 24 month follow up.
potential risk for shoulder pain is scapular dyskinesis, (altered position and/or
motion of the scapula). Scapula dyskinesis is thought to place abnormal forces
and disrupt the overall function of the glenohumeral joint, thereby increasing
the risk of shoulder pain and impairments. Interesting scapular dyskinesis is
often observed in both symptomatic and asymptomatic athletes. Therefore, it
remains unclear whether the presence of scapular dyskinesis increases the risk
of developing shoulder pain in asymptomatic athletes. To help investigate this
question the authors conducted a systematic review to identify whether the
presence of scapular dyskinesis in asymptomatic athletes increase the risk of
developing future shoulder pain. Following PRIMSA guidelines, the authors performed the search in 6 databases: Cochran Library, EMBASE, PubMed, CINAHL, SPORTDiscus. Inclusion criteria
comprised prospective studies within an athletic population that identified
whether these athletes were assessed for scapular dyskinesis, pain free at
baseline, and were assessed for pain at follow-up. The authors identified 5
articles that met the inclusionary criteria. Quality of these articles were
assessed using a modified version of the Downs and Black
guidelines,
where the max score was 20 instead of 30. Based on this modified scale the
average score was 16/20 (81%). Out of 419 athletes, 160 (38%) presented with
asymptomatic scapular dyskinesis. Over a period of 9 to 24 months 56 (35%) athletes
with scapular dyskinesis developed shoulder pain. In comparison 65 of the 259
athletes (25%) without scapular dyskinesis developed shoulder pain. The authors
found that the presences of scapular dyskinesis at baseline was indicative of a
43% increased risk of shoulder pain over a 9 to 24 month follow up.
The
authors found that athletes with scapular dyskinesis have a greater chance of
developing shoulder pain compared to athletes who did not have scapular
dyskinesis. In this current review 65% of the athletes had shoulder pain, and
only 25% did not have scapular dyskinesis. One important note to keep in mind
is that not all the athletes included were overhead athletes (70 rugby players).
Therefore, these athletes may not be at the same risk as an overhand athlete. It
is also critical to further evaluate the 160 athletes with scapular dyskinesis.
Only 56 of the athletes with scapular dyskinesis developed a painful shoulder;
therefore, the remaining 65% of those athletes remained asymptomatic over a
long period of time. Therefore, it remains inconclusive if scapular dyskinesis
contributes to the development of shoulder pain in athletes. Based on the
results of the study there is not a clear answer if scapular dyskinesis is a
risk factor for shoulder pain. Additional high-quality research studies are
required to add to the body of knowledge and to further understand the role of
scapular dyskinesis in the development of shoulder pain in athletes. The
authors also suggested that screening for several risk factors of shoulder pain
(range of motion, rotator cuff strength) including scapular dyskinesis would be
better than screening for scapular dyskinesis alone.
authors found that athletes with scapular dyskinesis have a greater chance of
developing shoulder pain compared to athletes who did not have scapular
dyskinesis. In this current review 65% of the athletes had shoulder pain, and
only 25% did not have scapular dyskinesis. One important note to keep in mind
is that not all the athletes included were overhead athletes (70 rugby players).
Therefore, these athletes may not be at the same risk as an overhand athlete. It
is also critical to further evaluate the 160 athletes with scapular dyskinesis.
Only 56 of the athletes with scapular dyskinesis developed a painful shoulder;
therefore, the remaining 65% of those athletes remained asymptomatic over a
long period of time. Therefore, it remains inconclusive if scapular dyskinesis
contributes to the development of shoulder pain in athletes. Based on the
results of the study there is not a clear answer if scapular dyskinesis is a
risk factor for shoulder pain. Additional high-quality research studies are
required to add to the body of knowledge and to further understand the role of
scapular dyskinesis in the development of shoulder pain in athletes. The
authors also suggested that screening for several risk factors of shoulder pain
(range of motion, rotator cuff strength) including scapular dyskinesis would be
better than screening for scapular dyskinesis alone.
Questions for Discussion:
Have you seen scapular dyskinesis as a risk factor for shoulder injury in your
clinical practice? Do you screen for scapular dyskinesis in your overhead
throwing athletes?
Have you seen scapular dyskinesis as a risk factor for shoulder injury in your
clinical practice? Do you screen for scapular dyskinesis in your overhead
throwing athletes?
Written by: Jane McDevitt, PhD
Reviewed
by: Jeff Driban & Steven Thomas
by: Jeff Driban & Steven Thomas
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I currently work with track and field and while we don't screen all our athletes for scapular dyskinesis it is something we assess when someone has a shoulder or upper back injury. I think would make sense that scapular dyskinesis is a risk factor that can lead to shoulder injury, but it is among many other risk factors that can cause shoulder injury. I also think many people live pain free with scapular dyskinesis by finding an adaptation pattern to compensate.
I currently work with a women's softball team and many of my athletes have scapular dyskinesis and a handful of those girls also suffer from a shoulder pathology. All of my shoulder rehabs include exercises to work on improving posture and scapular movement as I have found they are helpful when working with shoulder pathologies. I do not use any form of scapular dyskinesis screening right now but may be something to consider in the future.