“Scapulothoracic Dyskinesis” vs “STAM” (ScapuloThoracic Abnormal Motion)

Dear CSS:

This past year I was fortunate to have Bassem ElHassan join us at the Boston Shoulder Institute (www.bosshin.com ) at Mass General Hospital. Bassem is acknowledged as one of the world authorities on scapulothoracic problems. Recently, we had a discussion at our MGH indications conference about these problems. I thought it would be of interest to share my own perspective after 3 decades considering these problems. Historically, we understood abnormal scapulothoracic motion as “Scapulothoracic dyskinesis”. This term was actually first coined by Robert Leffert, MD (Past President ASES and Director of the Upper Extremity and Rehabilitation Service at MGH, ( http://www.orthojournalhms.org/volume11/Robert_Leffert.asp ) and Jacqueline Perry, MD (Leader in Biomechanics study of the shoulder and Gait analysis, https://www.healio.com/news/orthopedics/20130314/jacquelin-perry-dies ). Subsequently, I had conversations with Dr. Ben Kibler and others about what I had learned from Bob Leffert and Jacqueline Perry. Ben continued with his own interest in “Scapulothoracic Dyskinesis” and management of these problems. I am including an article by him here as well as other articles from others. There are a many orthopedic surgeons interested in this problem now, and Bassem ElHassan is redefining our understanding of both normal and abnormal scapular motion which he terms “STAM” (Scapulothoracic Abnormal Motion).

For my own part, I’ve been fascinated by the unique intercalated nature of the shoulder complex where many joints work together for overall motion. When the scapulothoracic articulation is not working appropriately all sorts of issues can affect the shoulder and present in a fashion which may mislead the surgeon in diagnosis and treatment selection. In 1987, when I was a Sports medicine Fellow at Children’s Hospital in Boston, I was interested to study patients with instability and rotator cuff problems to determine the incidence of “STAM” (at the time known to me as Scapulothoracic Dyskinesis). As there was no way to document this other than by visual inspection, I used a method for Scoliosis analysis called Moiré Topography. Enclosed is an article I authored in 1990 on our work.

Subsequently, I was impressed with how many patients I was seeing with failed surgical treatments including instability, biceps and rotator cuff tears. I am also enclosed several articles which document how errors in diagnosis are common and can lead to failed treatment.

One thing is for sure, proper examination of scapular mechanics in all patients presenting with shoulder problems is essential to establishing the correct diagnosis and appropriate treatment. Bassem ElHassan has helped us understand this and essential viewing is offered in his excellent video on Vumedi: https://www.vumedi.com/video/basic-exam-of-the-scapula-what-are-we-missing/

Kind Regards,

“JP” Warner, MD

Founder, The CSS

Kibler 2012- Scapular Dyskinesis and Its Relation to Shoulder Injury

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lee et al, JBJS 2015 - scapular winging evaluation and treatment AAOS exhibit selection

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Park et al

. JSES 2013 - How to assess scapular dyskinesis precisely; 3D wing computer tomo

Download JSES 2013 - HOW TO ASSESS SCAPULAR DYSKINESIS PRECISELY; 3D WING COMPUTER TOMO • 1.27MB

Rosso, et al

., JSES 2013 - The effect of simulated scapular winging on glenohumeral joint

Download , JSES 2013 - THE EFFECT OF SIMULATED SCAPULAR WINGING ON GLENOHUMERAL JOINT • 1.28MB

Srikumaran et al- JBJS-2014- Scapular Winging A great masquerader of shoulder disorders

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Warner and Navarro 1998- Serratus Anterior Dysfunction- Recognition and Treatment

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Warner et al, Clinical Orthopaedics and Related Research, 1991- Scapulothoracic Motion in

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