by leading surgeon Mr Ian Bayley
A frequent trigger for scapular dyskinesia or dyskinesis (winging scapula, shoulder blades that wing outwards or shoulder blade malfunction) is,
- A shortened collarbone
- Hunched shoulders
- Lifting weight in ‘bad form’
A broken collarbone shortened by as little as one millimetre can throw abnormal strain on the shoulder blades and other elements in the kinetic chain such as spine and pelvis, predisposing the patient to shoulder malfunction and future discomfort, injury and even disability.
The fragile relationship between muscle and bone framework can alter with devastating effect. Stronger muscles change role with weaker sets and instead of pulling the shoulder blades to the chest wall, muscles behave abnormally, pushing the shoulder blade(s) outwards. This is known as 'winging', and can also adversely affect pelvic and spinal alignment weakening posture, shoulders fall forward and if left unchecked, chronic or intense pain ensues with a life left compromised by an altogether avoidable condition.
"Our understanding of shoulder problems has increased in the forty years of my involvement in the field", says Ian. "We have come to understand the importance of the shoulder blade, how commonly it is compromised, and how resistant to surgery it can be."
So how do we tackle such an important and potentially life-changing condition?
Scapula dyskinesis comes in varying degrees. Its cause and affect little understood by practitioners, leaving its affects often undiagnosed and overlooked. Albeit a problematic condition to correct, it is treatable and we need to be able to treat all degrees of severity, not just the critical cases that come into my clinic.
One of the complications in treating the condition is the lack in the scapular (shoulder blade) of good mechanoreceptors - sensory receptors that transmit sensory information rapidly to the brain and the means by which the brain senses the position of shoulder joints/scapula.
Patients simply don't know if their scapula is winging, added to which the brain readily accepts the abnormal position and movement as normal.
For the vast majority of patients their symptoms are declared phantom or 'all in the mind', with physiotherapy becoming the first line of combat. For the majority, corrective exercise alone does not solve the problem, how can you correct something that the brain accepts as normal! With surgery very much a last resort and no promise of success, patients often fall through the health system disappointed and in despair.
We need new ways to tackle this very common condition. Having had first-hand experience of Angel Med’s ClaviBrace Gilet for broken collarbones, I am very excited by its potential, its unique ability to reset muscle memory and reprogram the brain to change habit, I believe, could hold the answer.
For me it obeys the crucial principle of supporting the three pillars or better, stepping stones - namely the pelvis, spine and shoulder blades – upon which effective shoulder function ultimately depends and it delivers this in a way acceptable to the wearer.
This is still a medical brace, but components are cleverly concealed in an everyday looking gilet and since long-term wear may be necessary, it avoids any feeling of self-consciousness.
Mr Ian Bayley is a senior consultant orthopaedic surgeon and shoulder expert, practicing at BMI Clementine Churchill Hospital, Harrow and No6 Harley Street, London.
He was appointed to open and direct the Spinal Injuries Unit at the Royal National Orthopaedic Hospital Stanmore in 1980 and to direct and develop the complex Shoulder Surgery Unit.
He also took on the role of National Clinical Chair of the NHS Orthopaedic Services collaborative and various subsequent service redevelopment roles on the national stage. His experience is therefore based firmly at “the coal face” of clinical practice and spans the whole medical spectrum from acute care through rehabilitation to community reintegration, combined with service redesign and delivery.
He is a member of the British Elbow & Shoulder Surgeons, British Orthopaedic Association and the European Shoulder & Elbow Society.
His clinical interest is in complex pain states, instability, rotator cuff pathology, primary and revision shoulder replacement.