The scapula is a large, triangular bone located in the upper back. This bone is surrounded and supported by a whole complex of muscles that are involved in the movements of the upper limb. If these muscles lose their strength or the balance in their work is disturbed due to injury or disease, the position of the scapula at rest or during movement may change.
Changing the position or mobility of the scapula can impede some types of arm movements, especially those associated with lifting it above the level of the head, and the patient may feel weakness in the shoulder. Such changes in the scapula, if also accompanied by changes in the normal healthy anatomical relationships in the shoulder joint, can cause injury to the shoulder joint.
Treatment for such shoulder blade deformities includes physical therapy to strengthen the muscles of the shoulder girdle and restore normal position and mobility of the shoulder blade.
Reasons for scapular dyskinesis:
- Weakness, imbalance, excessive tension, and separation of the muscles involved in the movements of the scapula
- Injury to the nerves that control these muscles
- Injury to the bones that support the scapula or intra-articular injury to the shoulder
Symptoms and diagnostics of diseases of the shoulder
The most common symptoms of scapular dyskinesia are:
- Pain and/or tenderness on palpation in the area of the scapula, especially in the area of its upper and inner edges
- Weakness of the corresponding shoulder girdle – you may feel tired and “numb” in your arm during any physical activity
- Muscle fatigue with repetitive movements, particularly when raising the arm above head level
- Restricted range of motion – you cannot raise your arm above shoulder level
- Crunching or clicking sensation when moving the shoulder girdle
- Visible extension or “pterygoid deformation” of the scapula
Physical examination for further physical therapy
The doctor will talk with you about your complaints and your general health and then examine your shoulder joint and scapula for signs of injury, weakness, or muscle tension. In most cases, the physical examination includes the following elements:
Visual inspection. The doctor will examine the changed shoulder blade and compare it with the healthy one. To detect dyskinesia, the doctor will ask you to raise and lower your arm 3-5 times; in some cases, you will additionally be asked to hold a small weight in your hand. This test usually detects weakness and imbalance in specific muscles.
Muscle strength research. The doctor will assess the strength of the muscles in the shoulder and the muscles surrounding the scapula to determine which muscle group is most responsible for the atypical movements of the scapula.
Corrective maneuvers. These are special clinical tests that help your doctor better understand your condition.
These tests include:
- Scapula maintenance test. When performing this test, the doctor asks you to raise your hand, and they gently press on the shoulder blade, facilitating its movement up. If your symptoms disappear and the range of motion increases, then you have a weakness in the muscles that lift the scapula.
- Retention test of the shoulder blade. In this test, the doctor evaluates the strength of the shoulder muscles by applying pressure to the abducted arm in the shoulder joint. The doctor then holds the scapula in its normal position with one hand and re-evaluates the muscle strength; in patients with dyskinesia of the scapula, muscle strength increases.
Lowering or forward bending of the shoulder girdle on the affected side
Physical therapy at home
In some cases, the symptoms of scapular dyskinesia can be leveled out by performing simple activities at home.
Restoration of normal posture. As you go about your daily activities, try to sit and stand correctly. Try to bring your shoulder blades together and pull your elbows back, as if you are trying to shove your hands into the back pockets of your pants.
Balanced exercise program. The exercise program must be balanced for upper body exercises. For each set of presses, you must do one set of swings and two sets of rowing. Your program should include exercises to strengthen the anterior shoulder muscles and the shoulder rotator muscles.
Heat therapy. Warm baths or local warming can help relieve excess muscle tension.
If symptoms persist, you should see your doctor. The doctor will help determine the exact cause of dyskinesia and prescribe appropriate treatment.
Conservative treatment after a visit to the doctor
In almost all cases of scapular dyskinesia, conservative treatment is effective.
Conservative activities include:
Non-steroidal anti-inflammatory drugs (NSAIDs). Drugs in this group, such as ibuprofen, can help manage pain and swelling.
Physical therapy. Your doctor or physiotherapist will recommend specific exercises to correct certain causes of dyskinesia.
- Exercises that help to strengthen the muscles that stabilize and carry out the movement of the scapula;
- Exercises that help to stretch overly taut muscles that restrict the movement of the scapula.
Most patients suffering from systemic dyskinetic syndromes associated with weakness or excessive muscle tension do not require surgical treatment.
However, if your dyskinesia is associated with a shoulder injury, your doctor may recommend surgery to repair damaged tissue. After the operation, rehabilitation treatment will be prescribed to help restore the normal mobility of the scapula.
After the causes of your scapular dyskinesis are eliminated with the normal position and mobility of the scapula restored, the doctor will recommend a set of exercises for you to maintain the achieved result. These exercises are most important if your work or lifestyle involves constant and intense stress on the shoulder joint.
Exercise should be done 3 times a week or at the frequency recommended by your healthcare professional.
The shoulder is a complex biomechanism. The shoulder joint is the only one in the human body that performs full rotation due to its anatomical structures. As soon as something is disturbed in this mechanism, even due to a minor injury, the shoulder does not work as it should. If it was not a serious injury, it is difficult to immediately determine the causes of pain, but the pain always has a provoking factor that can cause long-term pain and complications in the future.
Shoulder joint diagnostics
Various methods can be used to examine the shoulder joint. The most informative for the determination of traumatic bone injury is X-ray. Ultrasonography (ultrasound) is the first and foremost method for detecting soft tissue injury, which is the only method that examines the shoulder joint in motion to ensure that the tendon is undamaged after injury.
If during an ultrasound, damage, for example, of some element of the rotator cuff is ascertained, then magnetic resonance imaging (MRI) of the joint follows to assess damage to deeply located tendons and cartilage.
Most often, the shoulder joint is operated with an arthroscopic method.
This method has significant advantages: it is low-traumatic and gentle, and the incision sites heal quickly. New technologies make it possible to qualitatively and accurately assess the condition of the joint, even in places where it is impossible during a conventional surgical operation. The operation lasts up to 1.5 hours – it depends on the volume and complexity of the damage. It is performed on an outpatient basis at the ARS Day Hospital under general anesthesia. The patient can return home the following morning. The arm is freely suspended in a gusset band that protects against accidental movements.
For the shoulder to be at rest, it takes 4-6 weeks to wear a sling for the arm. Then, under the supervision of a physiotherapist, physical therapy begins. Rehabilitation lasts about 3 months, pain after surgery can last up to 3-4 months. It will take 5-6 months to fully regain its shape. The hand should be specially taken care of during this period. It is better to keep your hand for 2 months than not to move your whole life.