The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation

Abstract

We use the acronym SICK to refer to the findings one sees in this syndrome (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis of scapular movement). This recently recognized overuse muscular fatigue syndrome is yet another cause of shoulder pain in the throwing athlete who presents with dead arm complaints. 1 Morgan CD The thrower’s shoulder. Two perspectives. in: McGinty J.B. Operative arthroscopy. Ed 3. Lippincott Williams & Wilkins, Philadelphia2003: 570-584 Google Scholar The hallmark feature of this syndrome is asymmetric malposition of the scapula in the dominant throwing shoulder, which usually appears on examination as if one shoulder is lower than the other. This statically observable position is suggestive of underlying muscle activation alterations that produce altered kinematics of the scapula upon dynamic use. The altered kinematics fall into 3 clinically recognizable patterns of scapular dyskinesis, 2 of which are most commonly associated with labral pathology: type I, inferior medial scapular border prominence, and type II, medial scapular border prominence.