How reliable are tests that assess scapular dyskinesis?
Scapular dyskinesis describes an alteration of the normal scapular pattern and is not only commonly seen after shoulder injuries, but is also an associated risk factor for shoulder injuries. Tests to investigate scapular dyskinesis are used to identify the prevalence and the extent of a scapular dyskinesis. Scapular physical examination tests are performed in routine care, although it is not known if they are reliable. Thus, this systematic review aimed to investigate the reliability of these tests.
A comprehensive search in three different databases was performed and the quality was assessed by using the QAREL checklist. 15 studies were included in this review, and in total the reliability of 41 different physical examination tests for scapular dyskinesis were analysed.
Tests for the observation of scapular positioning / motion had an intrarater
reliability that ranged from 0.59 to 1.00 and an intrarater reliability from 0.31 to 0.84. Thus, the results on reliability were not homogenous and the usefulness of visual observation should be questioned.
Tests for the measurement of scapular positioning seemed to be reliable. Since these tests are performed in resting and non-resting position in a static manner they are probably not able to reproduce complex 3D-scapular movements. However, if altered scapular position or motion impairments are observed, further tests (e.g. for scapular muscle strength, length of soft tissue) might be useful to identify a good treatment.
Symptoms alterations tests such as the scapular assistance test (SAT) and the modified SAT were moderately interrater reliable (0.62 to 0.68). Especially the modified SAT should be considered reliable and might be helpful to identify whether the patient will benefit from a scapulothoracic approach.
However, the overall generalizability of this review results is limited due to the low quality of included studies and a lacking blinding of the assessors. Thus, further research is required.
> From: Lange et al., Phys Ther Sport (2016) (Epub ahead of print). All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.