Evaluation of the Scapula, Bassem Elhassan, MD | SDSI Shoulder Course 2022 скачать в хорошем качестве

Evaluation of the Scapula, Bassem Elhassan, MD | SDSI Shoulder Course 2022

www.sdsi-shoulder.com Understanding Scapular Dyskinesia: STAM Classification and Key Muscles What is Scapular Dyskinesia? Scapular dyskinesia refers to abnormal scapular motion, which can impact shoulder function. While some movements may appear pathological, it's crucial to differentiate between normal variations and dysfunction that cause pain or restricted mobility. STAM: A New Approach to Scapular Abnormalities To simplify diagnosis and treatment, the STAM (Scapulothoracic Abnormal Motion) Classification was developed. Unlike traditional classifications that focus on medial or lateral winging, STAM encompasses all abnormal scapular movements. Key Muscles Involved in Scapular Motion: Levator Scapulae – Elevates the scapula but does not lift the acromion. Rhomboids (Major & Minor) – Retracts the scapula toward the spine. Pectoralis Minor – Tilts the scapula anteriorly, mimicking winging. Serratus Anterior – Protracts and stabilizes the scapula during flexion. Trapezius – Elevates the scapula and prevents anterior tilt. Latissimus Dorsi – Plays a role in scapular positioning. If these muscles do not work in synchrony, scapular instability can occur, affecting overall shoulder function. STAM Classification Breakdown: STAM 1 – Pectoralis minor hyperactivity with anterior tilt. STAM 2A & 2B – Moderate abnormal scapular motion, with 2B requiring manual reduction. STAM 3 – Serratus anterior paralysis, leading to medial scapular winging. STAM 4 – Trapezius paralysis, causing lateralization and shoulder droop. STAM 5 – Combined trapezius and serratus anterior paralysis. STAM 6 – Severe locked scapula, mimicking dystonia. STAM 7A & 7B – Scapular "dancing," either during movement or at rest. Key Diagnostic Insights: Surface EMG Analysis helps differentiate hyperactive and hypoactive muscles. SFR Test (Shoulder Flexion Resistance Test) at 30°, 60°, and 100° distinguishes pectoralis minor hyperactivity from true serratus anterior paralysis. Wall Push-Up Test is less reliable than previously thought for diagnosing scapular winging. Conclusion: Understanding the STAM classification and the interplay of scapular muscles is crucial for diagnosing and treating shoulder instability. By identifying the root cause—whether it’s muscle hyperactivity, paralysis, or dyscoordination—clinicians can tailor treatments for better outcomes.