Scapular Dyskinesis

Scapular Dyskinesis or scapular dysfunction refers to the abnormal mobility or function of the scapula (shoulder blade). This is often a very subtle abnormality and it typically is not a primary complaint by the patient. However, it can be the underlying cause of the presenting shoulder pain.

The numerous muscles that attach to the shoulder blade (scapula) are responsible for the complex motions of the scapula, and any deviation from the normal can lead to damage to the rotator cuff, the shoulder labrum and cartilage. These muscles can become weak from underuse, muscle imbalance, or from an injury that results in either muscle damage or nerve damage that does not allow the correct signals to reach the muscle.

The diagnosis is made typically only by the correct physical exam tests performed by your surgeon, but is often missed. It can be very subtle in presentation, but can also be very dramatic (as seen in the picture above). More subtle presentations are certainly more common and often respond very well to the appropriate physical therapy program. The more significant conditions, especially those from permanent nerve damage, may be indicated for reconstructive surgery to re-route certain muscles to do the job of those that are not functioning correctly.

X-rays and MRI are typically not needed as this is a dynamic process best observed on physical examination. However the MRI may be useful to identify other injuries or pathology within the shoulder that are part of the dysfunction. A specialized nerve test will also typically be performed to evaluate the extent of nerve and muscle damage. This can help direct the level of treatment that may be required.