Does scapular dyskinesis affect top rugby players during a game season?

doi:10.1016/j.jse.2011.11.032

Journal of Shoulder and Elbow Surgery

Volume 21, Issue 6, June 2012, Pages 709-714

https://doi.org/10.1016/j.jse.2011.11.032 Get rights and content

Background

Scapular dyskinesis represents a considerable risk of shoulder injury to overhead athletes; however, there is a shortage of detailed epidemiologic information about scapular dyskinesis among the participants in collision sports.

Purpose

To describe the incidence and relationship of scapular dyskinesis to shoulder discomfort and variables related to the shoulder in top rugby players.

Methods

One hundred twenty top rugby football players in Japan were evaluated by means of questionnaires, physical examinations, and a video analysis during their preseason. Data were assessed by a logistic regression analysis calculating odds ratios. The primary outcome was processed to assess the relationship between scapular dyskinesis and other variables at the preseason. The secondary outcome was processed to assess an influence of scapular dyskinesis to shoulder discomfort during their regular season that were reassigned by second questionnaires.

Results

Scapular dyskinesis was identified in 33 (32%) shoulders, and type III was prominent. Scapular dyskinesis was significantly associated with shoulder discomfort (OR [odds ratio] = 4.4), and was also associated with variables of the affected shoulder. In addition, the players with asymptomatic scapular dyskinesis at the preseason would have high incident with shoulder discomfort during their regular season (OR = 3.6).

Conclusions

Scapular dyskinesis was associated significantly with both subjective and objective symptoms of the affected shoulder. These appearances may be of particular relevance in the early screening of chronic shoulder disorders in the rugby population. Further study to investigate and evaluate its reliability is needed to characterize its impact on the participants in collision sports.

Section snippets

Subjects

In 2009, one hundred twenty male roster players for top-league rugby teams in Japan, playing nearly 30 games during a regular season, were enrolled in this study. Twelve of them had participated in international games. Those who had shoulder or elbow surgeries in the past and those with a time-loss injury to shoulder or elbow in the previous 3 months were excluded. Examinations were conducted on both shoulders of each subject.

Demographics of the subjects

Demographic data were collected on all the subjects, using a

Results

The percentage of agreement representing inter-rater reliability in our evaluation of SD was 85.8% (103/120) and the kappa coefficient was .76. They correlated closely with the results reported by Kibler et al.¹⁵ Only the subjects whose ratings were in accordance by both raters were used for the final assessment. Consequently, 103 players were subjected to the primary analysis. In the population, SD was observed in 22 right shoulders (21.4%) and 13 (12.6%) left. The right shoulder was often

Discussion

The present study is the first preliminary one dealing with epidemiology of SD in rugby players. Of the top rugby players subjected to the study, SD was evident in 21.4% in the right shoulders and 12.6% in the left. The etiology and pathophysiology of SD would be different between collision sports (ie, rugby) and throwing sports (ie, baseball).¹⁴ SD itself can be considered to be an adaptation of the shoulder to the mechanical stress or injury.7, 23 The shoulders of rugby players are more prone

Conclusion

In conclusion, SD before and after a regular season was studied in a group of top-grade rugby players. The presence of SD, even asymptomatic before the season, was proved to be an alarming sign for shoulder problems. Therefore, SD should be further studied for prevention of various “rugby shoulders.”

Acknowledgments

The authors thank Makoto Urushibara, MD, Daisuke Kubota, MD, Yuji Takazawa, MD, Atsushi Kuwata, AT, Shigeru Ooka, AT, Chihiro Ota, AT, Mototsugu Matsui, Shingo Urayama, Koji Nishimoto, and Saya Hirabayashi for their valuable help in the data collection.

Disclaimer

None of the other authors, their immediate families, and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Cited by (46)

Shoulder kinetic during pitching in baseball players with scapular dyskinesis
2024, Journal of Bodywork and Movement Therapies
Shoulder injuries in baseball players cause excessive shoulder load during pitching and scapular dyskinesis (SD). However, the characteristics of pitching kinetics in the shoulder joint with SD are unclear. This study aimed to investigate the effect of SD on pitching kinetics in the shoulder joint of baseball players.
Seventy-two college and independent league baseball players participated in the study. The pitching motion was measured using an 18–camera motion-capture system. SD was classified into four types (I–IV) using the scapular dyskinesis test (SDT). The pitching kinetics data were analyzed.
The agreement of SD in this study was 56/72 (77.8%). SD were classified into 31 abnormal group (type I–Ⅲ) and 25 control group (type Ⅳ). Three participants with measurement failure during the pitching motion analysis were excluded from the analysis. The abnormal group showed a larger maximum value of the glenohumeral normalized anterior joint force than the control group.
These results suggest that an increase in GH anterior force during pitching causes an excessive increase in external rotation of the GH with an insufficient posterior tilt of the scapula with SD. Therefore, baseball pitching with SD may involve shoulder injuries owing to excessive shoulder load during pitching.
Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes
2023, Journal of Shoulder and Elbow Surgery
The alteration of scapular kinematics can predispose patients to shoulder pathologies and dysfunction. Previous literature has associated various types of shoulder injuries with scapular dyskinesis, but there are limited studies regarding the effect that proximal humeral fractures (PHFs) have on scapular dyskinesis. This study aims to determine the change in scapulohumeral rhythm following treatment of a proximal humerus fracture as well as differences in shoulder motion and functional outcomes among patients who presented with or without scapular dyskinesis. We hypothesized that differences in scapular kinematics would be present following treatment of a proximal humerus fracture, and patients who presented with scapular dyskinesis would subsequently have inferior functional outcome scores.
Patients treated for a proximal humerus fracture from May 2018 to March 2021 were recruited for this study. The scapulohumeral rhythm and global shoulder motion were determined using a 3-dimensional motion analysis (3DMA) and the scapular dyskinesis test. Functional outcomes were then compared among patients with or without scapular dyskinesis, including the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the visual analog scale (VAS) for pain, and the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L).
Twenty patients were included in this study with a mean age of 62.9 ± 11.8 years and follow-up time of 1.8 ± 0.2 years. Surgical fixation was performed in 9 of the patients (45%). Scapular dyskinesis was present in 50% of patients (n = 10). There was a significant increase in scapular protraction on the affected side of patients with scapular dyskinesis during abduction of the shoulder (P = .037). Additionally, patients with scapular dyskinesis demonstrated worse SICK scapula scores (2.4 ± 0.5 vs. 1.0 ± 0.4, P = .024) compared to those without scapular dyskinesis. The other functional outcome scores (ASES, VAS pain scores, and EQ-5D-5L) showed no significant differences among the 2 groups (P = .848, .713, and .268, respectively).
Scapular dyskinesis affects a significant number of patients following treatment of their PHFs. Patients presenting with scapular dyskinesis exhibit inferior SICK scapula scores and have more scapular protraction during shoulder abduction compared to patients without scapular dyskinesis.
Scapular dyskinesis type is associated with glenohumeral joint and scapular kinematic alteration during pitching motion in baseball players
2021, Journal of Bodywork and Movement Therapies
Scapular dyskinesis (SD) is associated with an increased risk of throwing-related shoulder injury onset, resulting in abnormalities in glenohumeral joint (GH) and scapular motions during pitching. The effects of SD on shoulder motion during pitching remain unknown. This study aimed to investigate kinematic alterations in GH and scapular motions during pitching in baseball players with type I SD.
Sixty-seven university and independent-league baseball players with and without SD were included. Pitching motion was measured using an optical three-dimensional motion capture system, and a SD test was conducted to evaluate SD. SD was classified into types I–IV. The inter-rater reliability of SD assessment was calculated using kappa coefficients. Three-dimensional GH and scapular kinematics during pitching motion were analyzed.
The percentage of agreement representing the inter-rater reliability of SD assessment was 77.6% (52/67; kappa coefficient: 0.72). Overall, 24 and 27 participants were categorized into abnormal (type I SD) and normal group (type IV SD), respectively, with normal scapular motion; one individual with type III SD was excluded. The abnormal group exhibited a significantly increased GH external rotation angle (9°) and decreased scapular posterior tilt angle (6°) during the maximum external rotation period compared with the normal group.
Baseball players in the abnormal group showed increased GH motion and decreased scapular motion during pitching. The SD test for the evaluation of type I SD can help predict excessive GH external rotation and decreased scapular posterior tilt during pitching.
Kinesiotaping for scapular dyskinesis: The influence on scapular kinematics and on the activity of scapular stabilizing muscles
2020, Journal of Electromyography and Kinesiology
Scapular dyskinesis is observed in 61% of overhead athletes (Burn et al., 2016). For most of them, it remains asymptomatic. However, scapular dyskinesis is considered a risk factor for shoulder injury by some authors (Clarsen et al., 2014). The aim of this study is to explore the effectiveness of kinesiotaping in modifying scapular kinematics and peri-scapular muscle activity in dyskinetic athletes. The 3-dimensional position and orientation of the scapula as well as the activation of upper trapezius, lower trapezius and serratus anterior were recorded in twenty asymptomatic athletes during shoulder movements (flexion and abduction), in loaded and unloaded conditions and in three circumstances (standard, kinesiotaping 1, kinesiotaping 2). A significant decrease between 9 and 12% in upper trapezius activity was observed with kinesiotaping 1 and 2. Lower trapezius activity was slightly increased with kinesiotaping 1 while it was significantly decreased about 15–20% with kinesiotaping 2. No change was observed in serratus anterior activity, for either kinesiotaping 1 or 2. Considering scapular kinematics, both kinesiotaping 1 and 2 significantly increased posterior tilt and upward rotation. External rotation was decreased with kinesiotaping 2, in comparison to standard condition. Kinesiotaping, and especially taping 1, seems to be an effective method for changing periscapular muscle activity and scapular kinematics.
Scapular dyskinesis in overhead athlete: Is it necessary to treat it?
2018, Journal de Traumatologie du Sport
Le rôle joué par la scapula dans la gestuelle sportive d’armé-lancer ou de frappe d’un projectile apparaît fondamental ; il concerne le placement et la mobilisation scapulaire adéquate pour faciliter la fonctionnalité de l’épaule. À l’inverse, une position ou une mobilisation inappropriée de la scapula lors de la gestuelle pourrait limiter la performance ou exacerber une lésion. La dysfonction scapulothoracique, appelée dyskinésie, s’avère fréquente dans l’épaule sportive incluant le membre supérieur ; elle s’observe chez des athlètes pathologiques, mais aussi dans l’épaule sportive asymptomatique. En présence d’une pathologie d’épaule, un bilan orienté doit permettre d’identifier une éventuelle dyskinésie. Le suivi rééducatif comprend alors une prise en charge spécifique dédiée aux causes fonctionnelles de cette dysfonction scapulothoracique. L’approche préventive s’avère également indispensable étant donné les liens mis en évidence par des études prospectives entre la présence d’une dyskinésie et la survenue lésionnelle. De plus, le bénéfice de l’intervention préventive apparaît démontré lors d’un suivi longitudinal de sportif intégrant un programme préventif par rapport à un groupe contrôle.
The role played by the scapula in the sporting gestures of arming-throwing or striking a projectile appears fundamental; it concerns placement and proper scapular mobilization to facilitate the functionality of the shoulder. On the other hand, an inappropriate position or mobilization of the scapula during the gesture could limit the performance or exacerbate an injury. Scapulo-thoracic dysfunction, called dyskinesia, is common in the sports shoulder including the upper limb; it is observed in pathological athletes, but also in asymptomatic sports shoulder. In the presence of a pathology of shoulder, an oriented balance should make it possible to identify a possible dyskinesis. The reeducative follow-up then includes a specific management dedicated to the functional causes of this scapulo-thoracic dysfunction. The preventive approach is also essential, given the links revealed by prospective studies between the presence of dyskinesia and the occurrence of lesions. In addition, the benefit of the preventive intervention appears to be demonstrated during a longitudinal follow-up of athletes integrating a preventive program compared to a control group.
Analysis of the kinetic chain in asymptomatic individuals with and without scapular dyskinesis
2018, Clinical Biomechanics
Citation Excerpt :
Due to the cross-sectional nature of most studies (Lawrence et al., 2014; Ludewig and Cook, 2000; Lukasiewicz et al., 1999), the question remains if scapular dyskinesis is cause or consequence of shoulder pain. However, recent prospective studies have showed that individuals with scapular dyskinesis may present with higher risk of developing shoulder pain than those without dyskinesis (Clarsen et al., 2014; Hickey et al., 2017; Kawasaki et al., 2012; Møller et al., 2017). Considering that scapular dyskinesis in interaction with other factors may increase the likelihood of developing shoulder pain, it would be interesting to evaluate if there are alterations in other segments of the kinetic chain, such as trunk and hips, in asymptomatic individuals with and without dyskinesis.
This study measured strength of the trunk and hip, and compared Y Balance Test and Upper Quarter Y Balance Test in individuals without and with scapular dyskinesis. Strength and endurance of the scapulothoracic muscles were also assessed.
Forty-four individuals without shoulder pain were divided in 2 groups: without scapular dyskinesis (age 26.00, SD 4.10 years) and scapular dyskinesis (age 23.68, SD 4.20 years). Scapular dyskinesis was assessed by clinical observation of the scapular motion during arm elevation, and was classified as present or absent. A handheld dynamometer was used to measure the isometric strength of the trunk flexors and lateral flexors, hip extensors and abductors, lower trapezius, serratus anterior, and latissimus dorsi. Y and Upper Quarter Y Balance Tests were performed with the individual in single-limb and 3-point plank position, respectively. Endurance of the scapulothoracic muscles was assessed with the individuals in prone with the arm at 135° abduction. Independent t-test and Mann-Witney test were used for comparison between groups. A P < 0.05 was considered significant. Effect sizes between groups were also calculated.
No differences (P > 0.05) were demonstrated between groups for all variables. Moderate effect size (d ~ 0.40) was found for the trunk flexors and hip extensors, and endurance of the scapulothoracic muscles, whereas the scapular dyskinesis group showed less strength and endurance in relation to the group without dyskinesis.
Strength of the trunk flexors and hip extensors, and endurance of the scapulothoracic muscles seem to have influence in scapular dyskinesis in non-athletes without shoulder pain.

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: Ethics approval: Ethics approval for the study was received from the Juntendo University School of Medicine Research Ethics Committee (No. 21067).

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ShoulderDoes scapular dyskinesis affect top rugby players during a game season?

Background

Purpose

Methods

Results

Conclusions

Section snippets

Subjects

Demographics of the subjects

Results

Discussion

Conclusion

Acknowledgments

Disclaimer

Arch Phys Med Rehabil

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

A biomechanical analysis of scapular rotation during arm abduction in the scapular plane

Am J Phys Med Rehabil

Laxity testing of the shoulder: A review

Am J Sports Med

Epidemiology of injuries in English professional rugby union, part 1: match injuries

Br J Sports Med

Epidemiology of injuries in English professional rugby union, part 2: training injuries

Br J Sports Med

Clinical measures of shoulder mobility in the professional baseball player

J Athl Train

The winged scapula

Clin Orthop

Traumatic winging of the scapula

J Bone Joint Surg Am

Serratus anterior paralysis in the young athlete

J Bone Joint Surg Am

Impingement syndrome in athletes

Am J Sports Med

Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries

Am J Sports Med

The role of the scapula in athletic shoulder function

Am J Sports Med

Shoulder
Does scapular dyskinesis affect top rugby players during a game season?