Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Thoraco-Scapular Instability

SYMPTOMS

There is anterior and or posterior shoulder pain and weakness in most active overhead and forward movements. A thrower cannot throw, a bowler cannot bowl, a tennis serve will be weak and boxers cannot hit hard.

AETIOLOGY

This is secondary shoulder pain caused by dysfunction of the scapula, causing anterior shoulder instability, pain and weakness. It could be due to a (rare) thoracic longus nerve paralysis, where there would be spontaneous winging on forward flexion, but is more commonly due to an inter-scapular muscle insufficiency and poor control, causing progressive winging of the scapula over a short time, while pressing against the wall or lifting or carrying a light object.

CLINICAL FINDINGS

Most shoulder joint tests are normal but pressing towards a wall gradually causes increased wing scapula and progressive anterior shoulder symptoms. In contrast with a thoracic longus nerve injury there is no immediate winging. Angel manoeuvres show poor thoraco-scapular control on the affected side.

INVESTIGATIONS

This is a clinical diagnosis.

TREATMENT

Physiotherapy, with thoraco-scapular training, cures this condition.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the diagnosis. In almost all cases, a thorough rehabilitation programme, including specific treatment, thoraco-scapular control training, strength, flexibility and posture training is required.

EXERCISE PRESCRIPTION

Most sports and activities are possible but secondary symptoms due to compensatory muscle activation are common and must be addressed. The specific rehabilitation should aim to achieve over time a full range of controlled motion, good posture and thoraco-scapular
control.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Press against the wall and angel manoeuvre tests should be negative. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

Many shoulder injuries can cause poor thoraco-scapular control as a
secondary problem.

PROGNOSIS

Excellent.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>