Context: Scapular motion evaluation is a necessary component of the upper extremity exam. Several methods exist, but most lack good reliability or diagnostic accuracy. The yes/no scapular dyskinesis test has the best of both measures but is untested on inexperienced clinicians. Objective: The purpose of this study was to evaluate the reliability and diagnostic accuracy of the yes/no scapular dyskinesis test when used by graduate assistant athletic trainers. Participants: The participants were college-aged students with no prior history of upper extremity fracture or nerve injury. Data Collection and Results: Participants were evaluated for scapular dyskinesis by a physician and 10 graduate assistant athletic trainers. Ratings were for normal or dyskinetic and then determination of side. Reliability was calculated using Gwet’s AC1 statistic and diagnostic accuracy from standard 2x2 contingency tables. Results: Reliability was moderate (AC1 = 0.48, p < 0.0025, 95% CI [0.147, 0.812]) when side was not accounted for and moderate (AC1 = 0.43, p < 0.0001, 95% CI [0.242, 0.632]) when side-per-side decisions were made. Sensitivity and negative predictive values were low to moderate (34.4%-66.2%, 8.9%-74.1% ). Specificity and positive predictive values were moderate to high (50%-85.2%, 51.5%-95.2%). Accuracy was moderate (65.2%-69.4%) and positive and negative likelihood ratios were low (1.325-2.333, 0.675-0.769). Conclusions: The reliability in this study was on par with previously published studies. Measures of diagnostic accuracy met or exceeded previous results. Clinically, to avoid false negative results and enhance the use of positive results, it appears necessary to combine methods and begin the evaluation with a gross assessment of whether or not dyskinesis is present and if it is to then evaluate which side is dyskinetic.

Rotator cuff disease is multi-factored and has been attributed to both intrinsic and extrinsic factors. Extrinsic factors contribute to compression of the rotator cuff tendons. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. Subacromial impingement is related to factors that encroach upon the subacromial space, while internal impingement affects the articular side of the tendons adjacent to glenoid. While the mechanisms of impingement are varied, further research is necessary to improve treatment and patient outcomes. Chapter 2 is a thorough review of literature on the mechanisms of rotator cuff disease. Alterations in scapular kinematics may influence subacromial space and either contribute to the etiology of subacromial impingement with rotator cuff tendon compression or serve as a compensation to alleviate compression. Furthermore alterations in scapular position may directly influence rotator cuff muscle strength. Chapter 3 compares the influence of the scapular assistance test on scapular upward rotation, posterior tilt, subacromial space, and shoulder strength between healthy individuals and subjects with subacromial impingement syndrome. Scapular upward rotation and posterior tilt induced with scapular assistance test appears to influence subacromial space, but not shoulder muscle strength; however, the influence of these scapular rotations do not differ between asymptomatic individuals and those with subacromial impingement. Furthermore scapular posterior tilt appears to have a greater influence on increasing subacromial space and should be emphasized in the treatment of individuals with subacromial impingement. In chapter 4, we examine the influence that obvious scapular dyskinesis and passive scapular correction with the scapular assistance test have on 3D scapular kinematics and subacromial space. Scapular dyskinesis did not alter scapular kinematics or acromiohumeral distance during active elevation in static positions, in the scapular plane, and without a load when compared to those without scapular dyskinesis. This suggests other contributing factors, such as pain, increased load, or fatigue is requisite to alterations in scapular kinematics or AHD. Passive correction with the scapular assistance test increased scapular upward rotation, posterior tilt, and subacromial space in individuals with and without dyskinesis. In patients with obvious dyskinesis, there was a greater increase in scapular upward rotation with passive scapular assistance. This increased scapular upward rotation had a negative relationship with change in the acromiohumeral distance. The scapular dyskinesis test increased acromiohumeral distance and therefore may be helpful identifying individuals where subacromial compression is producing symptoms, regardless of dyskinesis. The results of this research suggest scapular kinematics and subacromial space are altered with the passive maneuver of the scapular assistance test in all individuals, regardless of subacromial impingement syndrome or scapular dyskinesis. Scapular dyskinesis alone may not be detrimental to scapular position and subacromial space when evaluated in static positions of active arm elevation. Other potential factors may be required to alter scapular kinematics to reduce subacromial space including pain, dynamic movement, load or fatigue. Further study is necessary to determine the influence of the combination of these factors in individuals with scapular dyskinesis.

Thesis title: Effect of targeted training of the lower scapular fixators on the shoulder girdle function of rugby players The concept of the problem: Rugby is one of the toughest ball sports and there is no shortage of injuries. In addition, injuries in the shoulder area are among the most common and any possibility of reducing these injuries is beneficial. There is not much time left for compensation and targeted intervention; moreover, it is not usually led by physiotherapists but by fitness coaches and only in larger clubs. The consequence is a muscle imbalance in the shoulder girdle, which can result in the so-called scapular dyskinesis. This is turn affects the function and stability of the shoulder joint not only by the overhead athletes. It is possible to influence scapular dyskinesis in various ways. One of them is the inclusion of targeted training of lower scapular fixators into fitness training and thus their stability is improved. Objectives: The main aim of this thesis is to verify whether rugby players with painful shoulder have sufficiently scapular fixation based on kinesiological and biomechanical knowledge. Another aim of this thesis is to create such an exercise unit that would ensure the correct activity of the lower scapular fixators and verify this by measurement. The final...