Scapular Dyskinesis And The SICK scapula

Scapular Dyskinesis And The SICK scapula

What Is Scapula Dyskinesis

When discussing the shoulder joint scapulohumeral rhythm is a term referring to the coordinated movement between the scapula and humerus. The coordination of movement between the “socket” of the shoulder blade and the “ball” of the humerus (the upper arm bone) is vital for efficient, powerful and pain free movements of the upper limb. Without the coordination between the shoulder blade and arm, simple daily activities we take for granted such as hanging washing or throwing a ball, as well as common gym exercises involving overhead pushing and pulling activities such as the shoulder press, pull up, bench press, or push up are potentially at worst near impossible and at best lack power and fluidity. Coordinated scapulohumeral rhythm is important for full pain free shoulder movement, disruption to this rhythm through scapular dyskinesis can cause a syndrome referred to as a SICK scapula. In scapular dyskinesis the prefix “dys” a refers to “abnormal, or difficult” and kinesis refers to “motion,” so the term scapular dyskinesis indicates an abnormal moving shoulder blade. A SICK scapula is a common example of scapular dyskinesis we see in our Randwick physio practice.

Where the acronym S.I.C.K. stands for:

  • S – Scapula Malposition: which refers to the poor positioning of the shoulder blade.
  • I – Inferior Medial Border Prominence: referring to winging of the shoulder blade at the lower inside border closest to the spine.
  • C – Coracoid Pain and Malposition: Scapular pain at the front of the shoulder locating around the coracoid process and poor positioning of this process.
  • K – Kinesis Abnormalities of the Scapula: Abnormal shoulder blade movement associated with movement of the upper limb.

How Do You Spot A SICK scapula?

A SICK scapula is generally quite easy to spot when the arm is at rest. When viewed in standing from behind with the arms resting by the sides the shoulder on that side will appear lower referred to as “drooping”. And the lower inside border of the shoulder blade the side closest to the spine rather than hugging tightly to the rib cage, appears to be winging out away from the chest wall. Put simply, the SICK shoulder looks lower than the other side and appears as if you could slide your finger tips in-between the lower edge of the shoulder blade and the ribs. A SICK scapula can reduce glenohumeral joint stability, ultimately reducing the range of movement an individual has control over, reducing their functional strength. Left untreated a SICK scapula may develop into something more significant than simply visual asymmetry with accompanied mild strength or movement variations. In our Randwick sports physio practice we commonly see the SICK scapula presentation in our clients, particularly in throwing athletes and weight lifters, as well as in patients coming suffering with shoulder conditions including rotator cuff injuries, shoulder bursitis, shoulder impingement.

What Are The Causes That Lead To A Disruption In Normal Scapula Rhythm?

A SICK scapula can either result from previous injury, or painful conditions of the shoulder, or be itself a precursor to injury. The presence of a SICK scapula is fairly common in individuals who are repetitively performing strenuous above head activities. This could be in sporting situations for example tennis players, baseball pitchers, cricket bowlers, as well as in work settings such as painters, electricians and builders. The shoulder is no different to other systems and machines where all parts of the system must work together perfectly for smooth operation. Where muscles of the shoulder blade and shoulder must work together perfectly for optimal function. Tightness, weakness, imbalances, or instability any where within the “machine” can lead to both impaired shoulder function as well as an increase risk of injury and/or the onset of pain. As mentioned above the repetitive performance of overhead activities such as freestyle swimming, throwing a ball, or a tennis serve… can potentially create this exact situation. Repetitive throwing, or hitting actions can cause adaptive soft tissue changes over time, where certain muscles preferentially strengthen while other tissues tighten in an unbalanced fashion, leading to an equally unbalanced “machine”. The classic athletes we see with a SICK scapula at our Randwick physio practice include individuals heavily involved in swimming, weight lifting, as well as throwing or hitting sports. If you suspect you have a SICK scapula, or are experiencing shoulder pain that you suspect may be the result of some form of altered scapula rhythm then book in to see one of our physios. We can assess your shoulder and help you understand the root cause of your complaint, creating a treatment plan to get you back to your best again.
Disclaimer: The Movement Centre provides this information as an educational service. The information contained on this website and in this blog is not intended to serve as or replace actual medical advice. Anyone seeking specific advice or assistance should consult their local Randwick Physio, general practitioner, medical specialist, or otherwise appropriately skilled practitioner.