How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography-a new diagnostic modality

• Published in: Journal of shoulder and elbow surgery Vol. 22; no. 8; pp. 1084 - 1091
• Main Authors: Park, Jin-Young, MD, Hwang, Jung-Taek, MD, Kim, Kwang-Mo, MD, Makkar, Dheeraj, MD, Moon, Sung Gyu, MD, Han, Kyung-Jin, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.08.2013
• Subjects: 3D analysis; 3D wing CT; Adolescent; Adult; Child; Cohort Studies; Dyskinesias - classification; Dyskinesias - diagnostic imaging; Dyskinesias - physiopathology; Female; Humans; Imaging, Three-Dimensional; inter-rater reliability; Joint Diseases - diagnostic imaging; Joint Diseases - etiology; Joint Diseases - physiopathology; Male; observational assessment; Observer Variation; Orthopedics; Range of Motion, Articular - physiology; Reproducibility of Results; Scapula - diagnostic imaging; Scapula - physiopathology; Scapular dyskinesis; scapular movement; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Sports - physiology; Tomography, X-Ray Computed; Young Adult; 3D wing CT; Diagnostic Study; 3D analysis; inter-rater reliability; Scapular dyskinesis; observational assessment; scapular movement; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2012.10.046

Background Aberrations in scapular motion are believed to be associated with the presence of shoulder or elbow pathologies. There are many methods to evaluate scapular kinematics, but they have certain limitations. Nevertheless, it is believed that appropriate rehabilitation for each type of scapular dyskinesis is important. Methods Eighty-nine athletes were videotaped and seven blinded observers categorized scapular dyskinesis into 4 types, which was followed by 3-dimensional (3D) wing computer tomography (CT). Four blinded examiners evaluated 5 angles [upward rotation (UR), internal rotation (IR), anterior tilting (AT), superior translation (ST), and protraction (PRO)] on the 3D wing CT. Inter-rater reliability (IRR) was calculated for both the methods. CT scan measurements were compared with the 4 observational types to establish the validity. Results The IRR with observational assessment of scapular dyskinesis into 4 types was good, 0.780. The 3D wing CT analysis had a very high IRR, 0.972. There was a statistically significant correlation between observational assessment and 3D wing CT analysis. The UR angle, ST angle in type 3 scapular dyskinesis, and AT angle in type 1 scapular dyskinesis were increased as compared with those in the other types of scapular dyskinesis. All these measurements were made in the resting position of the scapula. Conclusion The 3D wing CT analysis allows precise quantification of a position associated with scapular dyskinesis. Therefore, 3D wing CT can be considered as an alternative method for assessing scapular dyskinesis.