Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

Tags: etiology, shoulder, biomechanics, pro, head/neck

Two articles on PainSci cite Hickey 2017: 1. Your Back Is Not Out of Alignment2. The Functional Movement Screen (FMS)

PainSci summary of Hickey 2017: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This paper’s initial title and abstract — which may change before it gets to print — were quite misleading, with the “conclusion” that “Athletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.” This seems to defy skepticism about the importance of scapular dyskinesia.

But this is a great example of statistics lying (or misleading): it’s only a 43% greater relative risk, relative to a small total count of injuries. The difference in absolute risk is very minor, and the authors concede in the body of the paper that “screening for scapular dyskinesia is not a useful approach to predict shoulder pain.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: It is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.

OBJECTIVES: To determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.

METHODS: A systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.

RESULTS: Five studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24-months follow-up (RR=1.43, 95%CI 1.05 to 1.93).

CONCLUSIONS: Athletes with scapular dyskinesis have 43% greater risk «relative! not absolute!» of developing shoulder pain than those without scapular dyskinesis.

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