Original article Comprehensive classification test of scapular dyskinesis: A reliability study Tsun-Shun Huang a , Han-Yi Huang a , Tyng-Guey Wang b , Yung-Shen Tsai c , Jiu-Jenq Lin a, * a School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC b Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan, ROC c Graduate Institute of Sports Equipment Technology, University of Taipei, Taiwan, ROC article info Article history: Received 16 June 2014 Received in revised form 17 October 2014 Accepted 28 October 2014 Keywords: Scapular dyskinesis Reliability Classification abstract Background: Assessment of scapular dyskinesis (SD) is of clinical interest, as SD is believed to be related to shoulder pathology. However, no clinical assessment with sufficient reliability to identify SD and provide treatment strategies is available. Objectives: The purpose of this study was to investigate the reliability of the comprehensive SD classi- fication method. Design: Cross-sectional reliability study. Method: Sixty subjects with unilateral shoulder pain were evaluated by two independent physiothera- pists with a visual-based palpation method. SD was classified as single abnormal scapular pattern [inferior angle (pattern I), medial border (pattern II), superior border of scapula prominence or abnormal scapulohumeral rhythm (pattern III)], a mixture of the above abnormal scapular patterns, or normal pattern (pattern IV). The assessment of SD was evaluated as subjects performed bilateral arm raising/ lowering movements with a weighted load in the scapular plane. Percentage of agreement and kappa coefficients were calculated to determine reliability. Results: Agreement between the 2 independent physiotherapists was 83% (50/60, 6 subjects as pattern III and 44 subjects as pattern IV) in the raising phase and 68% (41/60, 5 subjects as pattern I, 12 subjects as pattern II, 12 subjects as pattern IV, 12 subjects as mixed patterns I and II) in the lowering phase. The kappa coefficients were 0.49e0.64. Conclusions: We concluded that the visual-based palpation classification method for SD had moderate to substantial inter-rater reliability. The appearance of different types of SD was more pronounced in the lowering phase than in the raising phase of arm movements. © 2014 Elsevier Ltd. All rights reserved. The scapula plays several roles in normal shoulder function. First, the scapula functions as a stable part of glenohumeral artic- ulation. Appropriate alignment of the glenoid allows a congruent socket for the moving arm and maximizes concavity compression for shoulder joint stability (Matsen et al., 1991). Second, the scapula provides 3-dimensional movements in order for proper shoulder function to occur. During arm elevation, the scapula synchronously rotates upward, tilts posteriorly, and rotates externally to elevate the acromion to clear the subacromial space and thus avoid impingement (Ludewig and Cook, 2000; Neumann, 2010). Third, it is a link in a proximal-to-distal kinetic chain stretching from the ground, through the trunk and scapula, and to the end of the hand (Kibler, 1998). Appropriate scapular control allows efficient energy and force transfer to achieve shoulder function. Failure of the scapula to perform these roles results in insufficient physiology and biomechanics. This insufficiency may be related to decreased shoulder performance and shoulder injuries. Scapular dyskinesis is defined as alteration of scapular position and motion (Kibler et al., 2013). These include an abnormal scapula medial border and inferior angle prominence relative to the thoracic cage in the static position or dynamic motion, early scapula elevation or shrugging on arm elevation, as well as excessive/ inadequate/non-smooth upward and downward rotation of the scapula during arm elevation and lowering (McClure et al., 2009). Scapular dyskinesis has been reported in 68%e100% of patients with shoulder injuries, including glenohumeral instability, rotator cuff abnormalities, and labral tears (Warner et al., 1992; Paletta et al., 1997; Burkhart et al., 2000). Thus, scapular dyskinesis is believed to be related to shoulder pathology. * Corresponding author. Tel.: þ886 2 3366 8126. E-mail address: jiujlin@ntu.edu.tw (J.-J. Lin). Contents lists available at ScienceDirect Manual Therapy journal homepage: www.elsevier.com/math http://dx.doi.org/10.1016/j.math.2014.10.017 1356-689X/© 2014 Elsevier Ltd. All rights reserved. Manual Therapy 20 (2015) 427e432 Downloaded for Anonymous User (n/a) at Semmelweis University of Medicine from ClinicalKey.com by Elsevier on June 07, 2019. For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.