Differences in strength and fatigue resistance of scapular protractors and retractors between symptomatic and asymptomatic dyskinesis.

ABSTRACT

CONTEXT Scapular dyskinesis is a shoulder dysfunction that can be asymptomatic or associated with pain or weakness. Reduced strength and fatigue resistance of the scapular protractor and retractors muscles that stabilize the scapula might contribute to dyskinesis. OBJECTIVE: To determine the strength and fatigue resistance profiles of subjects with symptomatic and asymptomatic scapular dyskinesis, and to compare them to healthy controls using isokinetic assessment. DESIGN: Cross-sectional study. SETTING: University Hospital. PARTICIPANTS: Twenty healthy controls and 21 overhead athletes with symptomatic (n=10) and asymptomatic (n=11) scapular dyskinesis. MAIN OUTCOME MEASURES: Strength (peak torque, maximum work), fatigue resistance (total work) and protraction/retraction ratios measured during a closed-chain isokinetic protocol (40 repetitions in concentric mode at 24.4 cm/s). RESULTS: The scapular protractors' strength and fatigue resistance were significantly higher (p<0.01) in healthy controls (peak torque 5.0±0.9 N/Kg; maximum work 2.4±0.5 J/Kg; total work 72.4±0.6 J/Kg) than in asymptomatic (peak torque 3.4±0.7 N/Kg; maximum work 1.7±0.4 J/Kg; total work 50.0±13.7 J/Kg) and symptomatic (peak torque 3.8±0.6 N/Kg; maximum work 1.8±0.3 J/Kg; total work 58.1±12.9 J/Kg) dyskinetic participants. The dyskinetic symptomatic group presented the highest retractors' strength and fatigue resistance (p<0.01) values (peak torque 5.2±0.6 N/Kg; maximum work 2.9±0.8 J/Kg; total work 87.7±22.7 J/Kg) followed by the healthy controls (peak torque 4.7±1.0 N/Kg; maximum work 2.1±0.5 J/Kg; total work 65.3±17.9 J/Kg) and the asymptomatic dyskinetic participants (peak torque 3.9±1.0 N/Kg; maximum work 1.9±0.6 J/Kg; total work 58.6±18.5 J/Kg). The protraction / retraction ratios showed a gradual decrease (p<0.001) from healthy controls (1.1) to asymptomatic (0.9) and symptomatic (0.7) dyskinetic subjects. CONCLUSIONS: Scapular dyskinesis is characterized by weaker scapular protractors and reduced agonist/antagonist ratios, especially when symptomatic. Targeting the scapular protractors for a better balance of scapular musculature in rehabilitation and strengthening programs may improve shoulder symptoms and function, but more interventional studies are required.