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Current Reviews in Musculoskeletal Medicine
Erschienen in: Current Reviews in Musculoskeletal Medicine 6/2020

22.08.2020 | Sports Injuries and Rehabilitation: Getting Athletes Back to Play (R Gallo, Section Editor)

Scapular Dyskinesis and the Kinetic Chain: Recognizing Dysfunction and Treating Injury in the Tennis Athlete

verfasst von: Sundeep S. Saini, Sarav S. Shah, Alan S. Curtis

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 6/2020

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Abstract

Purpose of Review

This article aims to provide a comprehensive understanding of the evaluation, diagnosis, and management of scapular dyskinesis and its impact on the kinetic chain in tennis athletes.

Recent Findings

Optimal glenohumeral biomechanics are intimately associated with proper scapular motion and function. The tennis serve requires the scapula to act as a force transducer in the kinetic chain to convert potential energy generated in the lower extremities to kinetic energy in the upper extremity. Any aberration within this complex kinetic chain will result in force uncoupling and increases the potential for injury through compensatory mechanisms. Specifically, scapular dyskinesis has been associated with an increased risk of shoulder pain of up to 43% in overhead athletes. These pathologies include rotator cuff disease, subacromial and posterior impingement, labral injuries, and SLAP tears. Although the direct causality of these injuries remains controversial, multiple kinematic studies have demonstrated altered scapular positioning increasing the predilection for soft tissue pathology.

Summary

The diagnosis of scapular dyskinesis is predicated upon a thorough history, physical examination, and observational analysis of key nodes in the kinetic chain during tennis activity. Conservative management remains the mainstay of treatment and consists of a graduated physical therapy regimen. Although shoulder pain in the overhead athletes is often multifactorial, early recognition and treatment of scapular dyskinesis generally carry a favorable prognosis and result in improved patient outcomes.
Literatur
1.
2.
Lehman RC. Shoulder pain in the competitive tennis player. Clin Sports Med. 1988;7(2):309–27.PubMed
3.
Abrams GD, Renstrom PA, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med. 2012;46(7):492–8.PubMed
4.
Hutchinson MR, Laprade RF, Burnett QM 2nd, Moss R, Terpstra J. Injury surveillance at the USTA Boys’ Tennis Championships: a 6-yr study. Med Sci Sports Exerc. 1995;27(6):826–30.PubMed
5.
Winge S, Jorgensen U, Lassen NA. Epidemiology of injuries in Danish championship tennis. Int J Sports Med. 1989;10(5):368–71.PubMed
6.
• Hickey D, Solvig V, Cavalheri V, Harrold M, McKenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;52(2):102–10 This systematic review demonstrated that athletes with scapular dyskinesis have approximately a 43% greater risk of developing shoulder pain than those who do not, despite being asymptomatic.PubMed
7.
Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med. 2013;47(14):877–85.PubMed
8.
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641–61.PubMed
9.
McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elb Surg. 2001;10(3):269–77.
10.
Sonnery-Cottet B, Edwards TB, Noel E, Walch G. Rotator cuff tears in middle-aged tennis players: results of surgical treatment. Am J Sports Med. 2002;30(4):558–64.PubMed
11.
Mell AG, LaScalza S, Guffey P, et al. Effect of rotator cuff pathology on shoulder rhythm. J Shoulder Elb Surg. 2005;14(1 Suppl S):58s–64s.
12.
Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med. 2014;48(17):1327–33.PubMed
13.
Lopes AD, Timmons MK, Grover M, Ciconelli RM, Michener LA. Visual scapular dyskinesis: kinematics and muscle activity alterations in patients with subacromial impingement syndrome. Arch Phys Med Rehabil. 2015;96(2):298–306.PubMed
14.
• Shitara H, Kobayashi T, Yamamoto A, et al. Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3303–10 This study brings to light the recent controversy in the role of scapular dyskinesis as it pertains to shoulder injuries in the overhead athlete. This study found no significant association between a preseason diagnosis of scapular dyskinesis and subsequent shoulder injuries in a cohort of 105 high school baseball pitchers.PubMed
15.
Myers JB, Oyama S, Hibberd EE. Scapular dysfunction in high school baseball players sustaining throwing-related upper extremity injury: a prospective study. J Shoulder Elb Surg. 2013;22(9):1154–9.
16.
Kovacs M, Ellenbecker T. An 8-stage model for evaluating the tennis serve: implications for performance enhancement and injury prevention. Sports Health. 2011;3(6):504–13.PubMedPubMedCentral
17.
Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med. 2013;32(4):637–51.PubMed
18.
Kibler WB. Biomechanical analysis of the shoulder during tennis activities. Clin Sports Med. 1995;14(1):79–85.PubMed
19.
Elliott BC, Marshall RN, Noffal GJ. Contributions of upper limb segment rotations during the power serve in tennis. J Appl Biomech. 1995;11(4):433–42.
20.
Hirashima M, Kadota H, Sakurai S, Kudo K, Ohtsuki T. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. J Sports Sci. 2002;20(4):301–10.PubMed
21.
Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete's shoulder. Clin Sports Med. 2008;27(4):527–51.PubMed
22.
Ryu RK, McCormick J, Jobe FW, Moynes DR, Antonelli DJ. An electromyographic analysis of shoulder function in tennis players. Am J Sports Med. 1988;16(5):481–5.PubMed
23.
Abrams GD, Sheets AL, Andriacchi TP, Safran MR. Review of tennis serve motion analysis and the biomechanics of three serve types with implications for injury. Sports Biomechanics. 2011;10(4):378–90.PubMed
24.
Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthopaedic Surg. 2012;20(6):364–72.
25.
Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Scapular position and orientation in throwing athletes. Am J Sports Med. 2005;33(2):263–71.PubMed
26.
Rogowski I, Creveaux T, Sevrez V, Cheze L, Dumas R. How does the scapula move during the tennis serve? Med Sci Sports Exerc. 2015;47(7):1444–9.PubMed
27.
Forthomme B, Crielaard JM, Croisier JL. Scapular positioning in athlete's shoulder : particularities, clinical measurements and implications. Sports Med (Auckland, NZ). 2008;38(5):369–386.
28.
Elliott B, Fleisig G, Nicholls R, Escamilia R. Technique effects on upper limb loading in the tennis serve. J Sci Med Sport. 2003;6(1):76–87.PubMed
29.
Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD II, Harker P, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329–35.PubMed
30.
Wright AA, Wassinger CA, Frank M, Michener LA, Hegedus EJ. Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review. Br J Sports Med. 2013;47(14):886–92.PubMed
31.
Lee B, Kim D, Jang Y, Jin H. Three-dimensional in vivo scapular kinematics and scapulohumeral rhythm: a comparison between active and passive motion. J Shoulder Elb Surg. 2020;29(1):185–94.
32.
Ebaugh DD, McClure PW, Karduna AR. Scapulothoracic and glenohumeral kinematics following an external rotation fatigue protocol. J Orthop Sports Phys Ther. 2006;36(8):557–71.PubMed
33.
Umehara J, Kusano K, Nakamura M, Morishita K, Nishishita S, Tanaka H, et al. Scapular kinematic and shoulder muscle activity alterations after serratus anterior muscle fatigue. J Shoulder Elb Surg. 2018;27(7):1205–13.
34.
Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2009;25(1):40–5.PubMed
35.
Shields E, Behrend C, Beiswenger T, Strong B, English C, Maloney M, et al. Scapular dyskinesis following displaced fractures of the middle clavicle. J Shoulder Elb Surg. 2015;24(12):e331–6.
36.
Matsumura N, Ikegami H, Nakamichi N, Nakamura T, Nagura T, Imanishi N, et al. Effect of shortening deformity of the clavicle on scapular kinematics: a cadaveric study. Am J Sports Med. 2010;38(5):1000–6.PubMed
37.
Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elb Surg. 2002;11(6):550–6.
38.
Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med. 2006;34(10):1643–7.PubMed
39.
Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26(2):325–37.PubMed
40.
Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the scapular assistance test. J Orthop Sports Phys Ther. 2006;36(9):653–60.PubMed
41.
• Lange T, Struyf F, Schmitt J, Lützner J, Kopkow C. The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: a systematic review. Phys Ther Sport. 2017;26:64–89 This is a systematic review that highlights the lack of studies demonstrating inter- and intra-rater reliability for the most commonly used physical examination tests for the clinical assessment of scapular dyskinesis.PubMed
42.
Myers NL, Kibler WB, Lamborn L, Smith BJ, English T, Jacobs C, et al. Reliability and validity of a biomechanically based analysis method for the tennis serve. Int J Sports Phys Ther. 2017;12(3):437–49.PubMedPubMedCentral
43.
Wagner H, Pfusterschmied J, Tilp M, Landlinger J, von Duvillard SP, Müller E. Upper-body kinematics in team-handball throw, tennis serve, and volleyball spike. Scand J Med Sci Sports. 2014;24(2):345–54.PubMed
44.
Chou PP, Chou YL, Wang YS, Wang RT, Lin HT. Effects of glenohumeral internal rotation deficit on baseball pitching among pitchers of different ages. J Shoulder Elb Surg. 2018;27(4):599–605.
45.
Rose MB, Noonan T. Glenohumeral internal rotation deficit in throwing athletes: current perspectives. Open Access J Sports Med. 2018;9:69–78.PubMedPubMedCentral
46.
Thomas SJ, Swanik KA, Swanik CB, Kelly JD. Internal rotation deficits affect scapular positioning in baseball players. Clin Orthop Relat Res. 2010;468(6):1551–7.PubMed
47.
Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637–40.PubMed
48.
McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther. 2006;86(8):1075–90.PubMed
49.
Ladermann A, Chague S, Kolo FC, Charbonnier C. Kinematics of the shoulder joint in tennis players. J Sci Med Sport. 2016;19(1):56–63.PubMed
50.
Cools AM, Declercq G, Cagnie B, Cambier D, Witvrouw E. Internal impingement in the tennis player: rehabilitation guidelines. Br J Sports Med. 2008;42(3):165–71.PubMed
51.
Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elb Surg. 1992;1(5):238–45.
52.
Reuther KE, Thomas SJ, Tucker JJ, Yannascoli SM, Caro AC, Vafa RP, et al. Scapular dyskinesis is detrimental to shoulder tendon properties and joint mechanics in a rat model. J Orthop Res. 2014;32(11):1436–43.PubMedPubMedCentral
53.
Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, et al. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy. 2013;29(1):141–61 e126.PubMed
54.
Weiser WM, Lee TQ, McMaster WC, McMahon PJ. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med. 1999;27(6):801–5.PubMed
55.
Mihata T, Jun BJ, Bui CN, et al. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am. 2012;94(17):1576–83.PubMed
56.
Harryman DT 2nd, Sidles JA, Clark JM, McQuade KJ, Gibb TD, Matsen FA 3rd. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am. 1990;72(9):1334–43.PubMed
57.
Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am. 2005;87(4):824–31.PubMed
58.
Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692–7.PubMed
59.
Manske RC, Meschke M, Porter A, Smith B, Reiman M. A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health. 2010;2(2):94–100.PubMedPubMedCentral
60.
Struyf F, Nijs J, Mollekens S, Jeurissen I, Truijen S, Mottram S, et al. Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial. Clin Rheumatol. 2013;32(1):73–85.PubMed
61.
De Mey K, Danneels L, Cagnie B, Cools AM. Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome. Am J Sports Med. 2012;40(8):1906–15.PubMed
62.
Harris JD, Pedroza A, Jones GL. Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med. 2012;40(2):359–66.PubMed
63.
Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine WN, et al. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med. 2010;38(7):1456–61.PubMed
64.
Shah SS, Curtis AS. A 22-year-old female tennis player with shoulder pain. In: Kibler WB, Sciascia AD, editors. Mechanics, pathomechanics and injury in the overhead athlete: a case-based approach to evaluation, diagnosis and management. Cham: Springer International Publishing; 2019. p. 261–8.
Metadaten
Titel
Scapular Dyskinesis and the Kinetic Chain: Recognizing Dysfunction and Treating Injury in the Tennis Athlete
verfasst von
Sundeep S. Saini
Sarav S. Shah
Alan S. Curtis
Publikationsdatum
22.08.2020
Verlag
Springer US
Erschienen in
Current Reviews in Musculoskeletal Medicine / Ausgabe 6/2020
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-020-09672-6

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