Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with insidious onset of periscapular pain and mechanical shoulder dysfunction. Reports "snapping" or "winging" sensation during overhead activities. Symptoms exacerbated by repetitive reaching, lifting, or prolonged postural loading. Denies acute trauma, radicular symptoms, or night pain. Functional limitations noted in activities of daily living (ADLs) and athletic performance.
Clinical Examination Findings
Inspection reveals asymmetric scapular positioning at rest. Dynamic observation during active humeral elevation demonstrates dysrhythmia, characterized by premature scapular elevation or excessive protraction (SICK scapula syndrome). Palpation reveals tenderness at the medial border and superior angle of the scapula. Manual Muscle Testing (MMT) shows weakness in the serratus anterior, lower trapezius, and rhomboids. Scapular assistance test (SAT) and scapular retraction test (SRT) are positive, resulting in improved pain and range of motion.
Treatment Protocol
Initiate conservative management focusing on scapular stabilization and kinetic chain integration. Prescribe physical therapy targeting strengthening of the scapular stabilizers (serratus anterior, trapezius). Implement postural correction exercises and thoracic spine mobilization. Recommend activity modification to avoid provocative overhead movements. Consider NSAIDs for symptomatic relief and referral for specialized scapular dyskinesis rehabilitation protocols.