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scapulothoracic pathology - Coggle Diagram
scapulothoracic pathology
Role of scapula
-provides mobile base in all directions
-assists in providing correct muscle length to tension ratio for RC and deltoid
-critical in force transmission
3-D kinematics
scap motion occurs in 3 cardinal planes:
-elevation: UR. post tilt, and ER
-in scap plane: UR 50+/- 4.8 deg, ER 24+/- 12.8 degrees, post tilt 30 +/- 13 deg
muscular force-couples
-UT, LT, and SA for UR
-post tilt and ER from lower SA and LT
scap muscle activation changes with GH injury?
-yes. several studies show altered motor or onset of motor activity occur in those with impingement or GH instability
-diminished SA activity has been documented in throwers with unstable shoulders and swimmers with impingement
-delayed onset of SA in overhead reaching in swimmers with impingement
can abnormal scap movement be associated with RC impingement?
-yes. diminished scap movement particularly post tilt and superior elevation have been assocaited with impingement
scap dyskinesia
-very common
-warner: 64% of those with unstable shoulder and all patients with impingement demonstrated some degree of scap dyskinesia
should be suspected in OH athletes or patient's with pain in shoulder region, regardless of age
causes
-unclear whether is primary or secondary to shoulder pathology
-deficiency of scap musculature, especially SA and trap often implicated
-deficiencies may be weakness, tightness, or compensatory motor pattern
-congenital deformities such as scoliosis may cause scap dyskinesis
Sprengel's deformity:
-aka eulenburg's deformity
-failure of scap to descend during normal development
-seen in infancy as prominent lump in web of neck
-scap is hypoplastic, abnormally shaped, malrotated so sup medial angle is curved ant into supraclavicular region and inf angle of scap abuts thoracic spine
-abduction may be limited
-associated MS deformities include scoliosis, rib abnormalities, klippel-feil, and spina bifida are common
SICK scap
-scapular malposition
-inferior medial border prominence
-coracoid pain
-dyskinesis
-severe form of scap dyskinesis
-commonly found in OH athletes and can be noted by a unilateral drop in the affected shoulder
how is it assessed?
-observed during static and dynamic motion
lateral scap slide test: measures distance between T8 and inferior angle in three positions
-arm at side
-hands on waist
-arms abducted to 90 deg with max IR
->1.5 cm difference b/w sides indicative of scap muscle dysfunction
differences in vertical height to determine abnormal tilting or protraction
-"infera"
-measured with arms at side
-bubble goni to measure difference bw superomedial border
-large height difference is 2-3cm or more
which muscles should be targeted for rehab
-those most involved in scap stabilization against thoracic wall: rhomboids, trap, SA, and RC
which exercises target scap musculature
-push-up plus: 80% MVIC of SA
-prone flexion overhead: 95% for LT
-rows: 112% for UT/MT
-scap rehab should include core and LE strengthening program
dyskinesis vs winging
-winging assoc with long thoracic nerve palsy
-entire medial/inf border lifts off thoracic border due to SA deficiency
muscles that attach scapula and innervations: pg 368