Scapular Impairments: Managing Movement
Sarah Mottram MSc MCSP MMACP
The assessment of dynamic movement of the scapula is an important factor associated with shoulder dysfunction (Kibler & McMullen 2003). More recently the movement of the scapula has been investigated in people with neck pain (Helgadotirr et al 2010, 2011). This lecture will explore the influence of movement impairments (uncontrolled movement) of the scapula on neck and shoulder pain and function and detail retraining strategies.
A common feature of movement impairments is the reduced control of active movements (Luomajoki et al. 2007) and uncontrolled movement is defined as the inability to maintain this control with a movement at another joint (Comerford & Mottram 2012). The assessment of uncontrolled movement of the scapula will be detailed with movement control test including the Shoulder Flexion Scapular Movement Control Test (Mottram et al 2009) and the Kinetic Medial Rotation Test (Morrissey 2010).
A cognitive movement control retaining approach to manage scapula uncontrolled movement will be presented and will include: optimising the orientation of the scapula, maintaining this optimum alignment during arm elevation to 90°, and during muscle specific exercise motor control training for the trapezius and serratus anterior. Key retraining points for clinical application will be detailed.
Current research to support the assessment and retraining of scapula uncontrolled movement will be presented with a case study providing proof of concept for a motor control retraining intervention for managing uncontrolled scapula (Mottram et al. 2011).
Comerford M & Mottram S 2012 Kinetic Control: The Management of Uncontrolled Movement Elsevier
Helgadottir H, Kristjansson E, Mottram S, Karduna A, Jonsson H 2010 Altered scapular orientation during arm elevation in patients with insidious onset neck pain and whiplash associated disorder. J Orthop Sports Phys Ther 40(12); 784-791
Helgadottir H, Kristjansson E, Mottram S, Karduna A, Jonsson H 2011 J Altered alignment of the shoulder girdle and cervical spine in patients with insidious onset neck pain and whiplash associated disorders. Appl Biomech 27(3); 181-191
Kibler WB, McMullen J 2003 Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11:142-151
Ludewig P, Cook T 2000 Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 80(3):276-291.
Luomajoki H, Kool J, de Bruin ED, Airaksinen O 2007 Reliability of movement control tests in the lumbar spine. BMC Musculoskeletal Disorders; 8: 90
Morrissey D, Morrissey M, Driver W, King J, Woledge R 2008 Manual landmark identification and tracking during the medial rotation test of the shoulder: an accuracy study using three-dimensional ultrasound and motion analysis measures. Manual Therapy 13(6):529-35
Mottram S, Warner M, Chappell P, Morrissey D, M Stokes Impaired control of scapular rotation during a clinical dissociation test in people with a history of shoulder pain. 2009 3rd International Conference on Movement Dysfunction Edinburgh, UK
Mottram S, Warner M, Stokes M 2011 Retraining uncontrolled movement of the scapula: a single case study. 16th International WCPT Congress, The Netherlands