Management of Scapular Dyskinesis in Overhead Athletes

Optimal scapular function is integral to optimal shoulder function. Multiple roles of the scapula in arm function and throwing have been identified while scapular dysfunction continues to be associated with various shoulder pathologies. Although scapular motion alterations may be common in overhead athletes, various reports have shown that identification and management of the alterations can result in improved rehabilitation and performance outcomes. Considering that baseball throwing occurs as the result of integrated, multi-segmented, sequential joint motion and muscle activation within the kinetic chain, function and dysfunction within the kinetic chain needs to be understood. Furthermore, the scapula is a key component link within the chain through its function to maximize scapulohumeral rhythm and efficient throwing mechanics. Therefore, evaluation and management beginning with the scapula can produce improved outcomes related to shoulder pathology in overhead athletes. Although rehabilitation programs follow a core set of principles, they should be individualized based on the presentation of the patient and the needs for return to sport. This paper will describe scapular function in throwing, normal and abnormal scapular kinematics and muscle activations in throwing, discuss scapular dyskinesis as an impairment of function that can be associated with throwing injuries and altered performance, and how to detect impairments in order to establish proper treatment programs.