The scapula serves many roles in order for proper shoulder function to occur. Kibler wb medicine and science in sports and exercise 01 apr 1998, 304 suppl. The goal of shoulder rehabilitation is to restore the function of the. Clinical implications of scapular dyskinesis in shoulder injury. Shoulder dump shoulder dump to attain right shoulder external rotation and scapular retraction. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. Evaluation and management of scapular dyskinesis in. The goals of these protocols are to restore control of the scapula so that it maintains a posi. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. Scapular dyskinesis and its relation to shoulder pain. Shoulder injuries in tennis players british journal of.
Effective rehabilitation in patients with scapular. The importance of function of the central core of the body for stabilisation and force generation in all sports activities is being increasingly recognised. Shoulder rehabilitation strategies, guidelines, and practice. These roles include providing synchronous scapular rotation during humeral motion, serving as a stable base for rotator cuff activation and functioning as a link in the kinetic chain.
Pdf fundamental principles of shoulder rehabilitation. The role of core stability in athletic function 197. In the case of abnormal movements, socalled scapular dyskinesis, the tendons e. Pdf shoulder rehabilitation strategies, guidelines, and practice. Shoulder rehabilitation strategies,guidelines, and practice. Only one or two or all three patterns of dyskinesis can be found. Scapular dyskinesis and its relation to shoulder injury. Electromyography analysis of specific exercises for scapular control.
Assume a leftfootforward stance begin with the left hip flexed, trunk flexed and rotated to the left, and right arm at knee level a kinetic chain approach for shoulder rehabilitation mcmullen and uhl, j. Most of the methods and practice of shoulder rehabilitation are involved in strategies to normalize physiology and biomechanics of the shoulder motion. Core stability is seen as being pivotal for efficient biomechanical function to maximise force generation and minimise joint loads in all types of activities ranging from running to throwing. The role of the scapula in the rehabilitation of shoulder. Rehabilitation emphasis for scapular dyskinesis should start. Clinical examination of the shoulder, in pettrone fa ed. Shoulder injuries in tennis players are both a diagnostic and therapeutic challenge. The goal of shoulder rehabilitation is to restore the function of the shoulder. Rehabilitation programmes for rotator cuff tendinopathy need to take into account the potential for increased tendon thickness and reduced subacromial space after loading. To introduce an approach to shoulder rehabilitation that integrates the kinetic chain throughout the rehabilitation program while providing the theoretical rationale for this program. The physical examination should assess the impairments related to scapular dyskinesis in order to develop an appropriate rehabilitation. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty. Pdf the role of the scapula in the rehabilitation of. The role of core stability in athletic function springerlink.
The role of the scapula in the rehabilitation of shoulder injuries. Pdf rehabilitation of scapular muscle balance which. Abstract this framework for rehabilitation is consistent with the proximaltodistal kinetic chain biomechanical model and applies current concepts of motor control and closed chain exercises. Pdf this framework for rehabilitation is consistent with the. The role of the scapula in athletic shoulder function. Clinical implications of scapular dyskinesis in shoulder.
Introducing these exercises too early into the rehabilitation process will lead to overloading of these muscles and a delay in achieving rehabilitation goals. You are confronted with a tennis player presenting with pain when serving. Biomechanical analysis of the shoulder during tennis activities. The disabled throwing shoulder marianjoy medical library. The sick scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Shoulder rehabilitation can best be understood and implemented as the practical application of biomechanical and muscle activation guidelines to the repaired anatomic structures in order to allow the most complete return to function. Reprinted with permission from kibler wb, mcmullen j, uhl t. Ben kibler, md lexington clinic sports medicine center, lexington, kentucky.
Specific interventions should be based on the needs of the individual and should consider exam findings. The exact role and the function of the scapula are misunderstood in many clinical situations. Many current shoulder rehabilitation protocols include. Kibler wb clinics in sports medicine 01 jan 1995, 141. Ben kibler md medical director lexington sports medicine center lexington, ky articular sided partial rotator cuff tears have been identified very commonly in throwing athletes, most frequently in association with other shoulder injuries, especially superior glenoid labral tears 1. Biomechanical analysis of the shoulder during tennis. Always be sure to ice your shoulder after you complete your exercises. Make sure to rest from all painful activities until swelling subsides. The assessment is first performed with the patients arm at rest. An alteration of this ratio, specifically a decrease in upper trapezius and increase in serratus anterior activation, is a main area of focus in shoulder rehabilitation kibler, 1998. Ben kibler, md, john mcmullen, ms, atc, and tim uhl, pt, atc, phd shoulder rehabilitation can best be understood and implemented as the practical application of biomechanical and muscle activation guidelines to the repaired anatomic structures in order to allow the most complete return to function. Current concepts the role of the scapula in athletic.
Evaluation and management of scapular dyskinesis in overhead. To address these problems, dr ben kibler spearheaded the 2nd international conference on the scapula in. Pdf electromyographic analysis of specific exercises for. Function can be described in many different ways, but the framework for restoration of function should include restoration.
The second international consensus conference on the scapula was held in lexington kentucky. Scapular dyskinesis presenting in patients with shoulder pain may have multiple causes related to shoulder impairments or may simply be an incidental finding. Shoulder rehabilitation treatment includes activity modification, stretching, and strengthening the affected limb. Three types of rehabilitation scenarios exits for throwing athletes.
Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Function can be described in many different ways, but the framework for restoration of function. The role of the scapula in athletic shoulder function w. Current concepts the role of the scapula in athletic shoulder. Electromyographic analysis of specific exercises for. It was originally thought that the rotator cuff lesions. Rehabilitation protocol for total shoulder arthroplasty.
A kinetic chain approach for shoulder rehabilitation. Pdf closedchain rehabilitation for upper and lower. With manual repositioning of the scapula retraction the coracoid pain resolves and. Because of these advantages, they may be used early in rehabilitation and have been integral parts of accelerated rehabilitation programs. Pdf scapular dyskinesis and its relation to shoulder. Conservative to postoperative management article pdf available in arthroscopy the journal of arthroscopic and related surgery 189 suppl 2. Shoulder rehabilitation and injury prevention programs should include. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. Scapuladyskinesien aufgrund muskularer dysbalancen zhaw.
In addition, scapular rehabilitation is often ignored. For a balanced scapulohumeral rhythm in arm elevation, it is necessary to have an optimal position, motion, stability and muscle performance of the scapula and scapular muscles. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation show all authors. Closedchain rehabilitation for upper and lower extremities. Each role is vital to proper arm function and can only occur when the anatomy around the shoulder is uncompromised.
Kibler wb, sciascia ad, uhl tl, tambay n, cunningham t. It may increase the functional deficit associated with shoulder. Rehabilitation of scapular dyskinesis springerlink. The purpose of this paper is to provide a sciencebased clinical reasoning algorithm with practical guidelines for the rehabilitation of scapular dyskinesis in patients with chronic complaints in the upper quadrant. Biomechanical analysis of the shoulder in tennis is still in early stages. It occurs in a large number of injuries involving the shoulder joint and often is caused by injuries that result in the inhibition or disorganization of activation patterns in scapular stabilizing muscles. Optimal scapular function is integral to optimal shoulder function. Goran ivanisevic had a careerlimiting shoulder injury, martin verkerk took almost 2 years for his shoulder rehabilitation and johan santana is out for this season after reinjuring his shoulder. Rehabilitation protocol for reverse shoulder arthroplasty. Pdf the role of core stability in athletic function. Closed chains kibler wb, livingston advances in shoulder surgery and rehabilitation len funk 2012. Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation.
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