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      Associação entre discinesia escapular e dor no ombro de praticantes de natação Translated title: Association between scapular dyskinesia and shoulder pain in swimmers

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          Abstract

          A escápula possui funções essenciais no ombro do atleta de arremesso. Qualquer desequilíbrio presente entre as estruturas responsáveis pela sua estabilidade originará uma condição denominada discinesia escapular, a qual é comumente acompanhada de dor no ombro. Este estudo tem o objetivo de verificar se há associação entre a discinesia escapular e a dor no ombro de praticantes de natação. Foi realizado um estudo analítico observacional de corte transversal, incluindo 36 praticantes de natação do sexo masculino, com idade de 18 a 36 anos. Como métodos diagnósticos sugestivos de discinesia escapular foram utilizados o Slide Lateral Scapular Test e a filmagem proposta por Kibler. A existência de proporções significativas entre as variáveis nominais foi comprovada pelo teste do qui-quadrado ou pelo teste exato de Fisher. Para identificar associações entre as variáveis contínuas e os grupos de estudo foi utilizado o teste t de Student. Um p < 0,05 foi considerado estatisticamente significante. O grau de concordância interexaminador (Kappa; p < 0,0001) foi considerado substancial, correspondendo a 86,1% (0,7656) no ombro direito e 83,3% (0,6412) no esquerdo. Constatou-se que a grande maioria (80%) dos indivíduos que apresentaram positividade no Slide Lateral Scapular Test relatou dor no ombro. Dentre os nadadores que apresentaram discinesia escapular durante a filmagem, em 70,8% também foi constatada a presença dessa condição no teste estático. Este é um estudo original no que diz respeito à abordagem da discinesia escapular em nadadores e em relacioná-la com a presença de dor no ombro. Porém, a hipótese inicial de que haveria uma associação significante não foi correspondida.

          Translated abstract

          The scapula plays an essential role in the throwing motion performed by athletes. Scapular dyskinesia is a condition characterized by imbalance in the structures responsible for the joint stability, which is often accompanied by shoulder pain. The main objective of this study is to assess the relationship between scapular dyskinesia and shoulder pain in swimmers. A total of 36 male swimmers aged between 18 and 36 years were diagnosed for scapular dyskinesia utilizing two different methods: the Lateral Slide Scapular Test and the video recording method suggested by Kibler. Statistical analysis was performed using the Chi-square test or Fisher's exact test. Comparisons between groups were performed using the t-test. The degree of p< 0.05 was considered statistically significant. Significance was set at α=0.05. There was a high inter-rate reliability concerning the video analysis (Kappa; p<0.0001), corresponding to 86.1% (0.7656) on the right shoulder and 83.3% (0.6412) on the left shoulder. The majority of the individuals that had positive diagnosis assessed by the Lateral Slide Scapular Test (80%) reported pain on the shoulder. Furthermore, 70.8% of the subjects who had positive diagnosis by the video recording also had positive diagnosis in the static test. Although a significant association between scapular dyskinesia and shoulder pain was not found, this is an important study to approach these conditions in swimmers.

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          The role of the scapula in athletic shoulder function.

          W Kibler (2015)
          The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This "Current Concepts" review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the shoulder, and treatment and rehabilitation of scapular problems.
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            Scapular position and orientation in throwing athletes.

            Despite the recognized importance of proper 3-dimensional motion of the scapula in throwers, minimal research has quantified scapular position and orientation in throwing athletes. Throwing athletes exhibit scapular position and orientation differences when compared to nonthrowing control subjects. Descriptive laboratory study. Scapular position and orientation during scapular plane humeral elevation were assessed with electromagnetic tracking in a group of 21 throwing athletes and 21 control subjects. Scapular upward/downward rotation, internal/external rotation, anterior/posterior tipping, elevation/depression, and protraction/retraction were assessed. The throwing athletes demonstrated significantly increased upward rotation, internal rotation, and retraction of the scapula during humeral elevation. No differences in anterior/posterior tipping and elevation/depression were present. The results indicate that throwing athletes have scapular position and orientation differences compared to non-throwing athletes. This suggests that throwers develop chronic adaptation for more efficient performance of the throwing motion. Clinicians evaluate scapular position, orientation, and movement in throwing athletes as part of the evaluation of shoulder injuries associated with the throwing motion. The current study provides clinicians with an understanding of the types of adaptations that may be observed in normal, healthy throwing athletes.
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              Injuries to the shoulder in the throwing athlete. Part one: Biomechanics/pathophysiology/classification of injury.

              Over the last decade, significant advances have been made in the study and understanding of shoulder mechanics. Much of this may be attributed to the use of more sophisticated technology to improve our ability to assess the shoulder in real-time athletics. As a consequence of these advances, our understanding of the pathophysiology of injury has also increased. Our manual examination skills have improved and our noninvasive diagnostic techniques have advanced greatly. New insight into forces at play during actions as complex as the throwing motion has allowed us to develop better protocols for the prevention and treatment of the most common injuries. Additionally, paralleling improvements in the understanding of shoulder kinematics and the pathophysiology of injury, advances in surgical techniques, particularly arthroscopy, have aided in the diagnosis of and the development of less invasive surgical treatments for injuries that do not respond to nonoperative measures. Undoubtedly, an up-to-date understanding of the developments in shoulder biomechanics, pathophysiology of injury, diagnostic techniques, and surgical management is necessary for the clinician who wishes to continue to apply proper skills in the sports medicine setting.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbme
                Revista Brasileira de Medicina do Esporte
                Rev Bras Med Esporte
                Sociedade Brasileira de Medicina do Exercício e do Esporte (São Paulo )
                1806-9940
                October 2009
                : 15
                : 5
                : 342-346
                Affiliations
                [1 ] Universidade Católica do Salvador Brazil
                [2 ] Faculdades Integradas da Bahia
                [3 ] Centro Universitário Jorge Amado Brazil
                Article
                S1517-86922009000600004
                10.1590/S1517-86922009000600004
                15dec593-7f0d-40d7-b9a8-4c9e4c9b208d

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1517-8692&lng=en
                Categories
                PHYSIOLOGY
                SPORT SCIENCES

                Sports medicine,Anatomy & Physiology
                kinesiology,sports injuries,glenohumeral joint,cinesiologia,lesões no esporte,articulação glenoumeral

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