CME expires March 31, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

This Instructional Course Lecture (ICL) examines scapular dyskinesis and its contribution to common shoulder pathology via a case-based approach. The lecture bridges the gap between clinical observations and actionable therapeutic strategies, making it highly relevant for orthopaedic surgeons, particularly those specializing in shoulder surgery. Via case-based analyses, the lecture highlights the manner in which deviations in scapular function may contribute to complex shoulder disorders, such as impingement syndromes, rotator cuff disease, and labral tears.

The lecture outlines normal scapular mechanics and their disruption, offering a foundation for understanding the pathophysiology of scapular dyskinesis. The lecture examines the mechanical effect of scapular dyskinesis on glenohumeral rhythm, functional limitations, and implications on nonsurgical management (rehabilitation) and surgical management. A clinical framework for the evaluation of scapular dyskinesis that integrates diagnostic tests is presented, and underlying anatomic and physiologic factors contributing to shoulder dysfunction are identified.

Practical case examples illustrate real-world applications of these principles, demonstrating the manner in which effective management of scapular positioning and mechanics may optimize patient outcomes, even in challenging scenarios involving internal and external impingement or fractures of the clavicle or acromioclavicular joint. Emphasis is placed on personalized rehabilitation protocols that incorporate kinetic chain activation, motor control training, and targeted scapular stabilization exercises.

By synthesizing cutting-edge research, clinical insight, and therapeutic techniques, this lecture serves as a comprehensive guide for the diagnosis, management, and rehabilitation of scapular-related shoulder pathology.

Editor
Edward Walker Gallego, MD, FAAOS 

Learning Objectives

• Analyze the role of scapular mechanics in the pathophysiology of common shoulder pathology, particularly in overhead throwing athletes and individuals with repetitive shoulder use.
• Differentiate between pathoanatomic and pathophysiologic causes of scapular dyskinesis, and identify their effects on shoulder function and rehabilitation outcomes.
• Implement clinical evaluation techniques, including scapular assistance, scapular retraction, and the low row test, to assess scapular dyskinesis and its contribution to shoulder pain and dysfunction.
• Design personalized treatment strategies that address scapular dyskinesis by integrating flexibility, muscle activation, and kinetic chain rehabilitation approaches.
• Evaluate the implications of scapular positioning and kinematics on external and internal impingement, rotator cuff disease, and other shoulder pathology, considering surgical and nonsurgical management.
• Interpret imaging studies and physical examination findings to identify scapular-related dysfunction, such as labral tears or rotator cuff injuries, and develop appropriate treatment plans.
• Recommend surgical techniques for the management of malunion or nonunion of clavicular fractures and acromioclavicular joint injuries to restore scapulothoracic and glenohumeral kinematics.
• Construct rehabilitation protocols that emphasize the kinetic chain, incorporate motor control principles, and optimize muscle activation for shoulder stabilization and function.
• Apply evidence-based exercises, such as the scapular stability series and short-lever positioning techniques, to improve scapular control and minimize upper trapezius compensation.
• Assess the relationship between altered scapular kinematics and surgical outcomes, emphasizing the necessity of preoperative and postoperative scapular rehabilitation in improving patient outcomes.
• Integrate advanced diagnostic tools and clinical pathways to systematically evaluate the multifactorial causes of scapular dyskinesis and guide targeted management.
• Critique current research on the role of scapular kinematics and the kinetic chain in optimizing functional recovery in patients with complex shoulder pathology.

Earn up to 5 AMA PRA Category 1 CME credits™.