Detailed guides to painful problems, treatments & more

Dissing dyskinesis

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Recently in a discussion on Facebook, a chiropractor got annoyed with a physical therapist for calling shoulder dyskinesis a “dubious” clinical concept. He asked for evidence and linked to a PubMed search, suggesting that the existence of so many papers about it must mean it’s legit. This was too good a rebuttal opportunity for me to pass up: a slow pitch right across home plate. Evidence that shoulder dyskinesis is dubious? In those search results, it took me all of 10 seconds to find Wright et al on the first page, a nice fresh 2013 review in the British Journal of Sports Medicine concluding “no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.” Hard to treat what you can’t diagnose.

“Shoulder dyskinesis” is just fancy talk (elaborate parlance!) for “bad shoulder movement.” It’s a bogeyman for freelance therapists to chase for pay. With almost nonexistent diagnostic reliability, it’s clinically useless, a diagnosis that has more to do with sounding good than actually knowing anything helpful, so that they can stare at your shoulder for a couple minutes and wisely declare, “Well, there’s your problem,” as though it were obvious — to an expert, anyway. disclaimerThis is not to say that there is nothing ever wrong with shoulder movement. It is to say that it mostly defies useful interpretation and is much less important than supposed by some, just like most other diagnoses of dysfunctional movement and alignment.