Conservative Treatment of a Rotator Cuff Tear With Accompanying Scapular Dyskinesis: A Case Report

in International Journal of Athletic Therapy and Training
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  • 1 University of the Sunshine Coast
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A 20-year-old female, national-level, synchronized ice skater sustained a midsupraspinatus tendon tear (4 mm) in her left shoulder during a training session. Physical tests identified scapular dyskinesis on the involved side, and pain during shoulder flexion tasks. With no best practice identified for the conservative treatment of rotator cuff tears, treatment focused on correcting the scapular dyskinesis present. Within 12 weeks of treatment the patient was pain free, returned to full level of sport, and did not display any signs of scapular dyskinesis. These findings suggest that conservative treatment designed to correct scapular dyskinesis can be effective in alleviating pain and dysfunction associated with rotator cuff tears, as well as reducing time to return to full level of sport when compared to surgical interventions.

Turner is with the University of the Sunshine Coast, Sippy Downs, Queensland, Australia.

Turner (aturner@usc.edu.au) is corresponding author.
  • 1.

    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(14):877885. PubMed ID: 23580420 doi:10.1136/bjsports-2013-092425

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300305. PubMed ID: 19996329 doi:10.1136/bjsm.2009.058834

  • 3.

    Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of scapular dyskinesis in overhead and nonoverhead athletes: a systematic review. Orthop J Sports Med. 2016;4(2):2325967115627608. PubMed ID: 26962539 doi:10.1177/2325967115627608

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;52(2):102110. PubMed ID: 28735288 doi:10.1136/bjsports-2017-097559

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    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(2):160164. PubMed ID: 19295960

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Tate AR, McClure P, Kareha S, Irwin D, Barbe MF. A clinical method for identifying scapular dyskinesis, part 2: validity. J Athl Train. 2009;44(2):165173. PubMed ID: 19295961

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg. 2002;11(6):550556. PubMed ID: 12469078 doi:10.1067/mse.2002.126766

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):12401248. PubMed ID: 19896045 doi:10.1016/j.arthro.2009.06.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3):9098. doi:10.1016/j.pain.2010.10.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control. J Pain. 2001;2(3):135145. PubMed ID: 14622823 doi:10.1054/jpai.2001.19951

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Ervilha UF, Farina D, Arendt-Nielsen L, Graven-Nielsen T. Experimental muscle pain changes motor control strategies in dynamic contractions. Exp Brain Res. 2005;164(2):215224. PubMed ID: 15952017 doi:10.1007/s00221-005-2244-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Seida JC, LeBlanc C, Schouten JR, et al. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010;153(4):246255. PubMed ID: 20621893 doi:10.7326/0003-4819-153-4-201008170-00263

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. Br J Sports Med. 2007;41(4):200210. PubMed ID: 17264144 doi:10.1136/bjsm.2006.032524

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91(8):1898906. PubMed ID: 19651947 doi:10.2106/JBJS.G.01335

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Itoi E. Rotator cuff tear: physical examination and conservative treatment. J Orthop Sci. 2013;18(2):197204. PubMed ID: 23306597 doi:10.1007/s00776-012-0345-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Longo UG, Franceschi F, Berton A, Maffulli N, Droena V. Conservative treatment and rotator cuff tear progression. Med Sport Sci. 2012;57:9099. PubMed ID: 21986048 doi:10.1159/000328910

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with two years of clinical and imaging follow-up. J Bone Joint Surg Am. 2015;97(21):17291737. PubMed ID: 26537160 doi:10.2106/JBJS.N.01051

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014;48(8):692697. PubMed ID: 23687006 doi:10.1136/bjsports-2013-092148

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Medicine. 2007;35(10):17441751. doi:10.1177/0363546507303560

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Fortin JD, Roberts D. Competitive figure skating injuries. Pain Physician. 2003;6(3):313318. PubMed ID: 16880878

  • 21.

    Smith AD, Ludington R. Injuries in elite pair skaters and ice dancers. Am J Sports Med. 1989;17(4):482488. PubMed ID: 2782532 doi:10.1177/036354658901700406

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Holdgate A, Asha S, Craig J, Thompson J. Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med. 2003;15(5–6):441446.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Pluim BM. Scapular dyskinesis: practical applications. Br J Sports Med. 2013;47(14):875876. PubMed ID: 23973880 doi:10.1136/bjsports-2013-092722

  • 24.

    Willmore EG, Smith MJ. Scapular dyskinesia: evolution towards a systems-based approach. Shoulder Elbow. 2016;8(1):6170. PubMed ID: 27583003 doi:10.1177/1758573215618857

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Moura KF, Monteiro RL, Lucareli PR, Fukuda TY. Rehabilitation of subacromial pain syndrome emphasizing scapular dyskinesis in amateur athletes: a case series. Int J Sports Phys Ther. 2016;11(4):552563. PubMed ID: 27525180

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Klouche S, Lefevre N, Herman S, Gerometta A, Bohu Y. Return to sport after rotator cuff tear repair: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):18771887. PubMed ID: 26316611 doi:10.1177/0363546515598995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Goldberg BA, Nowinski RJ, Matsen FA III. Outcome of nonoperative management of full-thickness rotator cuff tears. Clin Orthop Relat Res. 2001;382:99107.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Hawkins RH, Dunlop R. Nonoperative treatment of rotator cuff tears. Clin Orthop Relat Res. 1995;321:178188.

  • 29.

    Townsend H, Jobe FW, Pink M, Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med. 1991;19(3):264272. PubMed ID: 1867334 doi:10.1177/036354659101900309

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Ballantyne BT, O’Hare SJ, Paschall JL, et al. Electromyographic activity of selected shoulder muscles in commonly used therapeutic exercises. Phys Ther. 1993;73(10):668677. PubMed ID: 8378423

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Reinold MM, Wilk KE, Fleisig GS, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther. 2004;34(7):385394. PubMed ID: 15296366 doi:10.2519/jospt.2004.34.7.385

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Dillman CJ, Fleisig GS, Andrews JR. Biomechanics of pitching with emphasis upon shoulder kinematics. J Orthop Sports Phys Ther. 1993;18(2):402408. PubMed ID: 8364594 doi:10.2519/jospt.1993.18.2.402

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Mall NA, Tanaka MJ, Choi LS, Paletta GA. Factors affecting rotator cuff healing. J Bone Joint Surg Am. 2014;96(9):778788. PubMed ID: 24806015 doi:10.2106/JBJS.M.00583

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Suprak DN, Sahlberg JD, Chalmers GR, Cunningham W. Shoulder elevation affects joint position sense and muscle activation differently in upright and supine body orientations. Hum Mov Sci. 2016;46:148158. PubMed ID: 26784707 doi:10.1016/j.humov.2016.01.008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Brindle TJ, Mizelle JC, Lebiedowska MK, Miller JL, Stanhope SJ. Visual and proprioceptive feedback improves knee joint position sense. Knee Surg Sports Traumatol Arthrosc. 2009;17(1):4047. PubMed ID: 18839143 doi:10.1007/s00167-008-0638-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Suprak DN, Osternig LR, van Donkelaar P, Karduna AR. Shoulder joint position sense improves with external load. J Mot Behav. 2007;39(6):517525. PubMed ID: 18055357 doi:10.3200/JMBR.39.6.517-525

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Yamauchi T, Hasegawa S, Matsumura A, Nakamura M, Ibuki S, Ichihashi N. The effect of trunk rotation during shoulder exercises on the activity of the scapular muscle and scapular kinematics. J Shoulder Elbow Surg. 2015;24(6):955964. PubMed ID: 25556806 doi:10.1016/j.jse.2014.10.010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    De Mey K, Danneels L, Cagnie B, Van den Bosch L, Flier J, Cools AM. Kinetic chain influences on upper and lower trapezius muscle activation during eight variations of a scapular retraction exercise in overhead athletes. J Sci Med Sport. 2013;16(1):6570. PubMed ID: 22658589 doi:10.1016/j.jsams.2012.04.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Wattanaprakornkul D, Halaki M, Cathers I, Ginn KA. Direction-specific recruitment of rotator cuff muscles during bench press and row. J Electromyogr Kinesiol. 2011;21(6):10411049. PubMed ID: 21978788 doi:10.1016/j.jelekin.2011.09.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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