Scapula or shoulder blade is a large triangular shaped bone which lies in the upper neck (T2 T7). The bone is surrounded by complex muscles which work together to move the arm, and further leads to injury if normal ball and socket alignment of the shoulder is not maintained. The scapula is an upper limb kinematic chain and is a vital component of glenohumeral rhythm. Normal range of motion in the shoulder is loose causing scapular dyskinesis. Men between 18-25 age are more likely to be diagnosed with scapular dyskinesis. The medical term of scapular dyskinesis (dys-alteration of , kinesis- movement). Commonly known as winged scapula as it is clinical observation where any part of the scapula departs excessively from the thorax and movement is initiated. In this article we are going to study its pathophysiology, causes, symptoms and many herbal medications in detail.
The glenohumeral joint is the gateway between the axial skeleton and the upper limb. The glenoid fossa and humeral head permits the multiplanar movement of joints.The balance between joint stability and movement is regulated by static and dynamic factors. In scapular dyskinesia patient complain of loss of function and pain with rotator cuff and shoulder capsule being the most common culprit.Scapular dyskinesia is musculoskeletal entity which is due to alteration in motion and position due to painful condition of the shoulder joint. Scapula can move in 4 planes- Elevation/depression, Retraction, internal external rotation, anterior posterior tilt. Glenohumeral joint and scapulothoracic articulation move in harmony. In scapular dyskinesis shoulder blades stick abnormally during rest and activity and stick out like a wings and which further causes great injury.
PATHOPHYSIOLOGY FOR SCAPULAR DYSKINESIS
Scapular dyskinesis is splitted into 3 groups-
- Shoulder related – The trapezius and serratus anterior muscle are linked in the development of dyskinesia as in both shoulder instability is seen. The most common forms of dyskinesia are Acromioclavicular instability, Rotator cuff injuries, Clavicle fracture, Nerve related, and disturbance in scapulohumeral rhythm. The tightness of muscles of the pectoral promotes anterior translation of the shoulder which causes stiffness in the glenohumeral capsule which alters the scapula position.
- Neck related – Two subtypes of neck pathology affect shoulder are-
- Mechanical neck pain (group of pathology which affects joints and muscles) of the neck due to western style and more use of computers causes slouched posture where cervical and thoracic spines lose their curvatures.
- Cervical nerve root syndrome – All the nerves which provides sensory and motor supply to shoulder originate from brachial plexus and accessory nerves, pathology arises when more than one nerve is activated around scapula and further disorganized the rhythm of scapula movement to main skeleton of upper limb.
- Posture related causes – Kyphosis and cervical lordosis changes the position of scapula. More changes are seen in athletes, which develops core muscles and imbalance the spinal curvature and soft tissue tension.
CAUSES OF SCAPULAR DYSKINESIS
- Muscle strain due to prolonged work in front of computer
- Heavyweight exercise
- Frozen shoulder
- Disease related to cancer and heart disease
- Improper posture
- Cervical spondylosis
- Poor lifestyle, hormonal imbalance
SYMPTOMS FOR SCAPULAR DYSKINESIS
- Pain and tenderness around the scapula on the top of the inner border.
- Weakness in the affected arm
- Fatigue with repeated activity
- Limited range of motion
- A crunching type of sound is felt around shoulder movement
- Winging of scapula
- Tilted posture of affected side
- Shoulder stiffness
- Chronic inflammation
- Injury to rotator cuff muscles
KIBLER CLASSIFICATION OF SCAPULAR DYSFUNCTION
- Type 1 or inferior dysfunction – Most common in patients with rotator cuff dysfunction. The primary external visual is prominent in inferior angle as anterior tilting of the scapula in the sagittal plane.
- Type 2 or medial dysfunction – Most commonly seen in patients with glenohumeral joint instability. It is due to internal rotation of the medial scapular border.
- Type 3 or superior dysfunction – This dysfunction is due to rotator cuff dysfunction and deltoid rotator cuff imbalances. It is compensatory hiking of the shoulder joint.
DIAGNOSTIC PROCEDURES FOR SCAPULAR DYSKINESIS
- Determining the presence and absence of dyskinesia
- Symptom altering test-
- Scapular retraction test
- Scapular assistance test
- Lateral scapular slide test
- Isometric scapular pinch test
- Wall pushup test
- Scapular load test
- Manual muscle testing (MMT)
- Static measurement
- Core evaluation
- Visual observation
- CT SCAN
- X- RAY
TREATMENT AND HOME REMEDIES FOR SCAPULAR DYSKINESIS
The main goal of therapy is to improve the kinematic chain at different levels from cervical and thoracic spine to shoulder.
- Non surgical treatment – Using non steroidal anti inflammatory drugs such as ibuprofen, which can relieve pain and swelling.
- Physical therapy usually focuses on – Strengthening the muscles to stabilize and move the scapula, stretching the tight muscles which are limiting scapular motions.
- Surgical treatment – This is followed by rehabilitation to restore the scapula normal motion.
REHABILITATION they are splitted into 3 stages-
- ACTIVE CONSCIOUS CONTROL – Surrounding structures are involved and neutral spine position is maintained respecting the curvature of spines at different levels. This effect rearranges the spine muscles to maintain neutral spine position and it is practised multiple times throughout the day.
- STRENGTH AND CONTROL FOR DAILY ACTIVITIES – It includes open chain and closed chain activity. Open chain includes inferior glide and it re-arranges the rhomboid muscles, whereas closed chain coordinates the rotator cuff muscles.
- CONTROL IN ATHLETIC PERFORMANCE – It adheres to the scapular control and task specific in muscle strength.
HOME REMEDIES FOR SCAPULAR DYSKINESIS
- Restore good posture – Perform good posture, try to sit and stand properly.
- Heat therapy – Soaking in a hot bath using a heat pad which helps to alleviate tight shoulder muscles.
- Balancing exercise routine – In this stretching exercise is included for shoulder joint rotation and for shoulder muscles.
AYURVEDIC MANAGEMENT FOR SCAPULAR DYSKINESIS
Ayurveda is an ancient science which has deep knowledge of the human body and provides the best cures for pain and injuries. Due to imbalance of vata dosha there is pain in the shoulder which makes movement difficult, due to imbalance of pitta dosha there are 4 changes felt in the shoulder (redness, heat, swelling, pain and there is loss of function). Due to imbalance of kapha doshas there is inflammation in the part of the shoulder. Many herbs and panchakarma therapy is effective in scapular dyskinesia which provides relief to patients without any side effects.
SOME HERBS FOR SCAPULAR DYSKINESIS
- Turmeric – Turmeric (Curcuma longa) has a warm bitter taste which decreases swelling, used in the treatment of inflammation. Commonly used for osteoarthritis, it controls high levels of cholesterol, reduces liver injury and takes up turmeric as it prevents fat buildup in the liver. Turmeric is used to control itching, and reduces pain by improving function in patients. Turmeric has an analgesic property.
- Ashwagandha – Ashwagandha has anti inflammatory and analgesic properties, reduces swelling, lowers the blood pressure and calms the activity of the brain. Ashwagandha improves the overall sleep and reduces stress and stress related weight gain.
- Ginger – Ginger has antibacterial properties, anti inflammatory as it reduces swelling as it is helpful in both rheumatoid arthritis and osteoarthritis. Ginger lowers the sugar level, and eases period pain. It has antioxidant compounds which prevent stress and fight against blood pressure, heart disease, and promote aging.
HERBAL REMEDIES BY PLANET AYURVEDA ON SCAPULAR DYSKINESIS
Planet Ayurveda is an ayurvedic clinic which provides great treatment with great results. All the formulations are prepared under strict observance of M.D AYURVEDA practitioners. These remedies are free from any kind of color, resins, gums, and any kind of synthetic material. As the remedies are 100% pure so they can be used without worrying about its side effects. For the purpose of management, planet ayurveda provides many formulations which include the following.
- Boswellia Curcumin
- Yograj Guggul
- RumoGin 5
- Ashwagandha Capsule
- Hakam Churna
1. Boswellia Curcumin
Boswellia curcumin is polyherbal capsules formulated by planet Ayurveda consisting of Shallaki (Boswellia serrata), Curcumin (Curcuma longa). Effective medicine for osteoarthritis, cervical spondylitis, Crohn’s disease, brain tumors. Boswellia has anti inflammatory and anti-arthritic action in both acute and chronic inflammation. Has antioxidant rich formula which is not only useful in joints but helpful in neuroprotective activity and maintaining the cardiovascular system.
Dosage: 1 capsule twice daily after meals with plain water.
2. Yograj Guggul
Yograj Guggul are in the form of herbal tablets which are formulated by planet ayurveda which consists of Amla (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica), Long pepper (Piper longum), Rasna (Pluchea lanceolata), Ajwain (Carum copticum), Vidanga (Embelia ribes), Ginger (Zingiber officinale), Tejpatra (Cinnamomum tamala), Black pepper (Piper nigrum) and many more. Yograj guggul increases digestion power, complexion, balances vata dosha disease which affects joints, bones, marrow. Plays an important role in neurological disorders such as paralysis, hemiplegia. It reduces pain, tingling sensation, in coccyx pain it is very helpful, in shoulder dislocation.
Dosage: 2 tablets twice daily with lukewarm water.
3. Rumogin 5 Capsules
Rumogin 5 capsules is herbal formulations in the form of capsules formulated by planet ayurveda consisting of Haridra (Curcuma longa), Sonth (Zingiber officinale), Shallaki (Boswellia serrata), Maricha (Piper nigrum), Pippali (Piper longum). The chronic disorders are well treated like morning stiffness, and in many bone spondylitis. Sonth is useful in respiratory disorders and long consumption of this medicine heals joints and maintains synovial fluid in the proper way. Pippali is useful for digestion and maintaining digestive fire.
Dosage: 1 capsule twice daily.
4. Ashwagandha Capsules
Ashwagandha capsules are single herbal capsules formulated by planet ayurveda using extracted formulation of Ashwagandha (Withania somnifera). It is a very useful formulation in diseases like stress, fatigueness, loss of weight due to cancer, and diabetes. Regular use of these capsules help to bring back strength to muscles and calms down the system. Ashwagandha is helpful in erectile dysfunction, premature ejaculation, and provides stamina and muscle power. Has anti stressor effect, and exhibits anti depressive effect. It works as an anti-inflammatory therefore restores blood supply and reduces swelling. Improves mental ability and curbs down the fatigueness and works as rasayan.
Dosage: 1 capsule twice daily with plain water after meals.
5. Hakam Churna
Hakam churna is polyherbal churna formulated by planet ayurveda using various ingredients – Chandrashoor (Lepidium sativum), Kalonji (Nigella sativaa), Methi (Trigonella foenum graecum), Ajwain (Trachyspermum ammi). Hakam churna is tridoshic rasyan and is anti spasmodic, anti inflammatory and in painful condition as in sciatica, stiffness. Hakam churna improves liver function and improves digestion. It reduces serum cholesterol and provides relief to anorectal pain.
Dosage: ½ tsp twice daily with warm water.
Scapular dyskinesis is loss of normal scapular mechanics, motion. It restricts the normal range of motions in shoulder blades. Weakness in bones, loss of flexibility, damage to nerves can cause scapular dyskinesis. In ayurveda it is due to all the three doshas as vata doshas cause pain and restricted movement of the shoulder, pitta dosha causes redness, swelling, heat and loss of function, kapha dosha causes inflammation in the shoulder. To balance this doshas many ayurvedic herbs and formulations by Planet Ayurveda are discussed above to provide relief to patients without any side effects.