A randomized controlled study to assess the effectiveness of structured exercise program in scapular dyskinesis among amateur tennis players attending various tennis academies in Jaipur.

Prevalence of injury in tennis players for shoulder injury is about 32 percent for overuse injury of the shoulder causing a mean absence from tennis of 2months plus (9.4 weeks) throughout a competitive year. Shoulder pain represents third most common injury among both male and female tennis players after ankle and knee pain and second most common overuse related condition, accounting for 8-20 percent of all tennis injuries.

 Shoulder pain in tennis players during serve and single hand backhand return is very common. As the shoulder joint is most mobile joint at the cost of susceptible to Instability which can lead to injury due to repetitive movements of extreme ROM in all directions in tennis as the average length of a game is 2 to 4 hours. Shoulder joint complex is formed by, humerus as appendices part and clavicle and scapula as a part of axial skeleton. To generate force for overhead activity ,54 percent of this force is generated by leg, hip and trunk and can be defined as force generator of the kinetic chain in serve and shoulder joint complex be seen as funnel and force regulator. Any pathology or pain in shoulder joint can cause breakage of a link in the proximal part of the kinetic chain which can lead to a higher demand on the more distally located segment that is elbow and wrist, only enhancement of functional ability of the distal segment will result in the same level of energy at the end of kinetic chain. This is called as catch-up phenomenon . Glenohumeral rhythm should be proper for pain-free movements at shoulder joint. Stability of scapula plays important role for shoulder movements, provided by dynamic and static stabilizers, as it acts as stable base for the humeral head during the overhead movement to generate a congruent socket and it has to move around the thoracic wall while the arm follow through. In the same way scapula has to move in an upward direction in order to clear the acromion process from moving humeral head and finally it from a stable base for intrinsic and extrinsic muscles that control arm motion and position of scapula against thorax, fine tuning of scapular motion is provided by coupling of muscle. The overhead activity as in tennis serve or in throwing sports is an unnatural and highly dynamic, often exceeding the physiological limits of the shoulder making it susceptible to injury. Any weakness or tightness in dynamic stabilizers of scapula can cause an alteration or deviation in the normal resting or active position of the scapula during shoulder movement known as scapular dyskinesis .

 Scapular Dyskinesis can lead pain during overhead movement at shoulder joint due to impingement. Scapular abnormalities were more evident during dynamic assessment than during static testing in participants with impingement and Instability. Mild scapular dyskinesis is more frequently evident during the lowering phase of arm movement, presumably because of the neuromuscular control required during eccentric muscle contraction. Scapular dyskinesis test is done by video tapping arm flexion and abduction in frontal plan, each test movement (flexion and abduction) rated as normal motion, subtle abnormality and obvious abnormality. After finding abnormal movement of scapula a structured 12 week exercise program for scapular stabilizers is given and evaluation done for scapular dyskinesis by video tapping, and strength in internal and external rotation of shoulder joint.