Scapular balance angle

Original Editor - Ruchi Desai Top Contributors -

Purpose

The condition of altered scapular mechanics and motion is called ‘scapular dyskinesis’, where ‘dys’ indicates alteration and ‘kinesis’ indicates motion. it can be found in healthy individuals or be responsible for a syndrome characterised by several symptoms called SICK. (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and DysKinesis of scapular motion).

scapular balance angle (SBA) is defined as “the difference between the angles formed by the line joining the 2 inferior angles of the scapula with the vertical line passing through the spine”

The most common pathologies that are associated with some form of scapular Dyskinesis are: (1) Acromio clavicular instability, (2) shoulder impingement, (3) rotator cuff injuries, (4) Glenoid labrum injuries, (5) clavicle fracture and (6) nerve-related.

Technique

• The Scapular balance angle measurement is obtained with the patient standing on both bare feet, with arms, pelvis, and heels together.
• Next, the inferior angle of the scapula was marked bilaterally and the line connecting these marks and another vertical line between the C7 and T9---T10 spinous processes were drawn.
• Lastly, the angles formed by the line joining both inferior angles of the scapula with the vertical line running through the spine were measured with the goniometer.
• The SBA was defined as ‘‘the difference between the angles formed by the line joining the 2 inferior angles of the scapula with the vertical line passing through the spine. SBA greater than 7 ◦ would entail the diagnosis of scapular dyskinesia.
• Manual measurement of the SBA is reproducible at an intra observer (ICC: 0.87) and inter observer (ICC: 0.84) level.
• This criterion presented a sensitivity of 72.73%, specificity of 90.91% and odds ratio of 8.

Figure-1 shows scapular balance angle

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Figure-2 shows scapular angle measurement on the right side

Evidences

• Manual measurement of the SBA is reproducible at an intra-observer (ICC: 0.87) and inter-observer (ICC: 0.84) level.

• This criterion presented a sensitivity of 72.73%, specificity of 90.91% and odds ratio of 8.

Physiotherapy Management

Conservative treatment in SD cases aims to restore scapular retraction, posterior tilt, and external rotation. Specific exercises for scapular rehabilitation include flexibility exercises to decrease scapular traction, and scapular stabilization exercises to optimize scapular kinematics.

Scapular stabilization exercises, based on stretching and strengthening, aim to improve muscle strength and joint position sense    The serratus anterior and trapezius muscles act as scapular stabilizers.

The serratus anterior plays an essential role in determining scapular external rotation and posterior tilt, and the lower trapezius helps to stabilize the scapular position.

Scapular stabilization exercises are based on closed and open kinetic chain exercises, including push-ups on a stable or unstable surface, lawnmower exercises, and resisted scapular retraction.