Skip to main content
SpringerLink
Log in

The Scapula and Impingement/Rotator Cuff Disease and Treatment

  • Chapter
  • First Online:
Disorders of the Scapula and Their Role in Shoulder Injury

  • 1813 Accesses

Abstract

Scapular dyskinesis is present in most shoulder injuries (68–100%) [1]. Major progress has occurred in our understanding of scapular dyskinesis. Scapular dyskinesis is now identified around the world and the implications are broad. Our understanding of the scapula now extends far beyond our rudimentary basis of “scapular winging” and neurologic conditions. We can now begin to explore the impact of the scapula on other conditions and explore a more cause and effect relationship. The scapula establishes a platform for effective rotator cuff function and normal shoulder motion. Alterations in scapular motion can be associated with multiple pathologic conditions including rotator cuff weakness and rotator cuff pathology [2]. Clinical data and experimental model systems, including cadaveric and animal models, have also been developed to assess the role of the scapula in impingement and rotator cuff disease. Currently, there is limited evidence to guide our treatment or prevention of rotator cuff injuries that may be secondary to scapular dyskinesis. A better understanding of the role of the scapula in rotator cuff pathology would help optimize clinical management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26:325–37.

    CAS  PubMed  Google Scholar 

  2. Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete's shoulder. Clin Sports Med. 2008;27:527–51. doi:10.1016/j.csm.2008.07.007.

    Article  PubMed  Google Scholar 

  3. McClure P, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis, part 1: reliability. J Athl Train. 2009;44:160–4. doi:10.4085/1062-6050-44.2.160.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Merolla G, De Santis E, Campi F, Paladini P, Porcellini G. Infraspinatus scapular retraction test: a reliable and practical method to assess infraspinatus strength in overhead athletes with scapular dyskinesis. J Orthop Traumatol. 2010;11(2):105–10. doi:10.1007/s10195-010-0095-x. Epub 2010 Jun 1. PMID: 20514507.

  5. Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the scapular assistance test. J Orthop Sports Phys Ther. 2006;36:653–60. doi:10.2519/jospt.2006.2234.

    Article  PubMed  Google Scholar 

  6. Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med. 2013;47:877–85. doi:10.1136/bjsports-2013-092425.

    Article  PubMed  Google Scholar 

  7. Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Ichinose T, Takasawa E, et al. The impact of faulty posture on rotator cuff tears with and without symptoms. J Shoulder Elb Surg. 2015;24:446–52. doi:10.1016/j.jse.2014.07.012.

    Article  Google Scholar 

  8. Halder A, Zobitz ME, Schultz F, An KN. Mechanical properties of the posterior rotator cuff. Clin Biomech. 2000;15:456–62. S0268-0033(99)00095-9 [pii]

    Google Scholar 

  9. Kandemir U, Allaire RB, Jolly JT, Debski RE, McMahon PJ. The relationship between the orientation of the glenoid and tears of the rotator cuff. J Bone Joint Surg. 2006;88:1105–9. doi:10.1302/0301-620X.88B8.17732.

    Article  CAS  Google Scholar 

  10. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C.Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: a radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B(7):935–941. doi:10.1302/0301-620X.95B7.31028. PMID: 23814246.

  11. Wong AS, Gallo L, Kuhn JE, Carpenter JE, Hughes RE. The effect of glenoid inclination on superior humeral head migration. J Shoulder Elb Surg. 2003;12:360–4. doi:10.1016/S1058-2746(03)00026-0.

    Article  Google Scholar 

  12. Karduna AR, Kerner PJ, Lazarus MD. Contact forces in the subacromial space: effects of scapular orientation. J Shoulder Elb Surg. 2005;14:393–9. doi:10.1016/j.jse.2004.09.001.

    Article  Google Scholar 

  13. Mihata T, Jun BJ, Bui CN, Hwang J, McGarry MH, Kinoshita M, et al. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am. 2012;94:1576–83. doi:10.2106/JBJS.J.01972.

    Article  PubMed  Google Scholar 

  14. Labriola JE, Lee TQ, Debski RE, McMahon PJ. Stability and instability of the glenohumeral joint: the role of shoulder muscles. J Shoulder Elb Surg. 2005;14:32S–8S. doi:10.1016/j.jse.2004.09.014. S105827460400271X [pii].

  15. Thompson WO, Debski RE, Boardman 3rd ND, Taskiran E, Warner JJ, Fu FH, et al. A biomechanical analysis of rotator cuff deficiency in a cadaveric model. Am J Sports Med. 1996;24:286–92.

    Article  CAS  PubMed  Google Scholar 

  16. Soslowsky LJ, Carpenter JE, DeBano CM, Banerji I, Moalli MR. Development and use of an animal model for investigations on rotator cuff disease. J Shoulder Elb Surg. 1996;5:383–92. S1058-2746(96)80070-X [pii].

    Google Scholar 

  17. Reuther KE, Thomas SJ, Tucker JJ, Yannascoli SM, Caro AC, Vafa RP, et al. Scapular dyskinesis is detrimental to shoulder tendon properties and joint mechanics in a rat model. J Orthop Res. 2014;32:1436–43. doi:10.1002/jor.22693.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Reuther KE, Thomas SJ, Tucker JJ, Vafa RP, Gordon JA, Liu SS, et al. Overuse activity in the presence of scapular dyskinesis leads to shoulder tendon damage in a rat model. Ann Biomed Eng. 2014; doi:10.1007/s10439-014-1137-y.

    PubMed  PubMed Central  Google Scholar 

  19. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elb Surg. 2010;19:116–20. doi:10.1016/j.jse.2009.04.006.

    Article  Google Scholar 

  20. Harris JD, Pedroza A, Jones GL, Group MS. Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med. 2012;40:359–66. doi:10.1177/0363546511426003.

    Article  PubMed  Google Scholar 

  21. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:216.

    Google Scholar 

  22. Flatow EL, Soslowsky LJ, Ticker JB, Pawluk RJ, Hepler M, Ark J, et al. Excursion of the rotator cuff under the acromion. Patterns of subacromial contact. Am J Sports Med. 1994;22:779–88.

    Article  CAS  PubMed  Google Scholar 

  23. Prato N, Peloso D, Franconeri A, Tegaldo G, Ravera GB, Silvestri E, Derchi LE. The anterior tilt of the acromion: radiographic evaluation and correlation with shoulder diseases. Eur Radiol. 1998;8(9):1639–46. doi:10.1007/s003300050602. PMID: 9866777.

  24. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5. PMID: 16595470.

    Google Scholar 

  25. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elb Surg. 1995;4(6):454–61. PMID: 8665291.

    Google Scholar 

  26. Boehm TD, Rolf O, Martetschlaeger F, Kenn W, Gohlke F. Rotator cuff tears associated with os acromiale. Acta Orthop. 2005;76(2):241–4. PMID: 16097551.

    Google Scholar 

  27. Ogata S, Uhthoff HK. Acromial enthesopathy and rotator cuff tear. A radiologic and histologic postmortem investigation of the coracoacromial arch. Clin Orthop Relat Res. 1990;(254):39–48. PMID: 2323148.

    Google Scholar 

  28. Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE et al. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res. 2003;(407):86–91.

    Google Scholar 

  29. Pandey V, Jaap Willems W. Rotator cuff tear: a detailed update. Asia Pac J Sports Med Arthroscopy Rehabil Technol. 2015;2(1):1–14. doi:10.1016/j.asmart.2014.11.003.

    Article  CAS  Google Scholar 

  30. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39:90–104. doi:10.2519/jospt.2009.2808. 2289 [pii].

  31. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moiré topographic analysis. Clin Orthop Relat Res. 1992;(285):191–9. PMID: 1446436.

    Google Scholar 

  32. Kijima T, Matsuki K, Ochiai N, Yamaguchi T, Sasaki Y, Hashimoto E, Sasaki Y, Yamazaki H, Kenmoku T, Yamaguchi S, Masuda Y, Umekita H, Banks SA, Takahashi K. In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders. J Shoulder Elb Surg. 2015;24(11):1817–26. doi:10.1016/j.jse.2015.06.003. Epub 2015 Jul 30. PMID: 26234667.

  33. Leong HT, Tsui SS, Ng GY, Fu SN. Reduction of the subacromial space in athletes with and without rotator cuff tendinopathy and its association with the strength of scapular muscles. J Sci Med Sport. 2016;19(12):970–4. doi:10.1016/j.jsams.2016.03.011. pii: S1440-2440(16)30007-X. [Epub ahead of print] PMID: 27102401

  34. Lopes AD, Timmons MK, Grover M, Ciconelli RM, Michener LA. Visual scapular dyskinesis: kinematics and muscle activity alterations in patients with subacromial impingement syndrome. Arch Phys Med Rehabil. 2015;96(2):298–306. doi:10.1016/j.apmr.2014.09.029. Epub 2014 Oct 15. PMID: 25449194.

  35. Michener LA, Sharma S, Cools AM, Timmons MK. Relative scapular muscle activity ratios are altered in subacromial pain syndrome. J Shoulder Elb Surg. 2016;25(11):1861–7. doi:10.1016/j.jse.2016.04.010. pii: S1058-2746(16)30065-9. [Epub ahead of print] PMID: 27374236.

  36. Struyf F, Cagnie B, Cools A, Baert I, Brempt JV, Struyf P, Meeus M. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol. 2014;24(2):277–84. doi:10.1016/j.jelekin.2013.12.002. Epub 2013 Dec 18. Review. PMID: 24389333.

  37. Wadsworth DJ, Bullock-Saxton JE. Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. In J Sports Med. 1997;18:618–24. doi:10.1055/s-2007-972692.

    CAS  Google Scholar 

  38. Scibek JS, Carpenter JE, Hughes RE. Rotator cuff tear pain and tear size and scapulohumeral rhythm. J Athl Train. 2009; 44(2):148–59. doi:10.4085/1062-6050-44.2.148. PMCID: PMC2657030.

  39. Van de Velde A, De Mey K, Maenhout A, Calders P, Cools AM. Scapular-muscle performance: two training programs in adolescent swimmers. J Athl Train. 2011;46(2):160–7; discussion 168–9. doi:10.4085/1062-6050-46.2.160. PMID: 21391801.

  40. Bury J, West M, Chamorro-Moriana G, Littlewood C. Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: a systematic review and meta-analysis. Man Ther. 2016;25:35–42. doi:10.1016/j.math.2016.05.337. Epub 2016 Jun 4. PMID: 27422595.

  41. Reijneveld EA, Noten S, Michener LA, Cools A, Struyf F. Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review. Br J Sports Med. 2016. doi:10.1136/bjsports-2015-095460. pii: bjsports-2015-095460. [Epub ahead of print] Review. PMID: 27251897.

  42. Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elb Surg. 2013;22:1371–9. doi:10.1016/j.jse.2013.01.026.

    Article  Google Scholar 

  43. Reuther KE, Tucker JJ, Thomas SJ, Vafa RP, Liu SS, Gordon JA, et al. Effect of scapular dyskinesis on supraspinatus repair healing in a rat model. J Shoulder Elb Surg. 2015;24:1235–42. doi:10.1016/j.jse.2014.12.029.

    Article  Google Scholar 

  44. Denard PJ, Bahney TJ, Kirby SB, Orfaly RM. Contact pressure and glenohumeral translation following subacromial decompression: how much is enough? Orthopedics. 2010;33:805. doi:10.3928/01477447-20100924-02.

    PubMed  Google Scholar 

  45. Soslowsky LJ, Thomopoulos S, Esmail A, Flanagan CL, Iannotti JP, Williamson 3rd JD, et al. Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors. Ann Biomed Eng. 2002;30:1057–63.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 500 W. 120th Street, New York, NY, 10027, USA

    Katherine E. Reuther PhD

  2. Department of Orthopedics, Lexington Clinic Orthopedics --Sports Medicine Center, The Shoulder Center of Kentucky, Lexington, KY, USA

    Brent J. Morris MD

  3. Vanderbilt University, Nashville, TN, USA

    John E. Kuhn MD, MS

Authors
  1. Katherine E. Reuther PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brent J. Morris MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John E. Kuhn MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John E. Kuhn MD, MS .

Editor information

Editors and Affiliations

  1. Lexington Clinic Orthopedics and Sports Medicine Center, Lexington, Kentucky, USA

    W. Ben Kibler

  2. Eastern Kentucky University, Richmond, Kentucky, USA

    Aaron D. Sciascia

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Reuther, K.E., Morris, B.J., Kuhn, J.E. (2017). The Scapula and Impingement/Rotator Cuff Disease and Treatment. In: Kibler, W., Sciascia, A. (eds) Disorders of the Scapula and Their Role in Shoulder Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-53584-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-53584-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-53582-1

  • Online ISBN: 978-3-319-53584-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation