II. Causes

  1. Overhead throwing athlete

III. Pathophysiology

  1. Weakness of the Scapula stabilizers
    1. Serratus anterior muscle
    2. Infraspinatus muscle
    3. Deltoid muscle
    4. Trapezius muscle
  2. Tension on muscles opposing the Scapular stabilizers
    1. Levator Scapulae muscle
    2. Upper trapezius muscle
    3. Pectoralis muscle
  3. Results in malpositioning of the Scapula (Mnemonic SICK)
    1. Scapula malposition (rotated counter-clockwise)
    2. Inferior medial border prominent
    3. Coracoid process pain and malposition
    4. Dyskinesis of Scapular movement
      1. Increased angulation of Humerus at glenoid
      2. Decreased subacromial space (risk of Shoulder Impingement)

IV. Symptoms

  1. Pain at coracoid process (especially with throwing motion)

V. Management

  1. Modified activity
  2. Physical Therapy: Pectoralis muscle stretch
    1. Patient lies supine over a towel (or foam roll) positioned parallel with the Thoracic Spine
    2. Patient presses the Shoulders posteriorly

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