Rehabilitation Incorporating a Stroke Efficiency Analysis in a Male Tennis Player with Scapular Dyskinesis: A Case Report.

Background: Scapular dyskinesis (SD) is a common co-morbidity with shoulder complex injuries. However, the presence of shoulder pain (SP) with SD is inconsistent, suggesting a need for individualized assessment and treatment approaches. The purpose of this case report is to describe the differential diagnosis of an athlete with SD and SP and a rehabilitation strategy integrating physical therapy (PT) with a Stroke Efficiency Rating Analysis/Injury Risk Assessment (SER/IRA) to identify biomechanical faults during the tennis serve. Case Description: A 23-year-old male tennis player with right SP was referred to PT by his coach. The subject's SP had been intermittent for nine years, presenting during and after serving and recently intensified, limiting his activities of daily living (ADLs). The subject was diagnosed with secondary shoulder impingement with long head of the bicep and rotator cuff tendinopathy attributed to SD. He completed a 16-week, four-phase rehabilitation program incorporating the SER/IRA and revisions to the biomechanics of his service action, leading to symptom resolution and return to pain-free tennis and ADLs. Outcomes: The subject's pain level during and after playing tennis decreased from 8/10 to 1/10 following the intervention. The Upper Extremity Functional Score improved by 11 points, while the Disabilities of the Arm, Shoulder, and Hand Questionnaire (disability/symptom and work/sports modules) decreased by 20.87 and 56.25 points, respectively, reflecting clinically meaningful change. The subject returned to tennis and ADLs without pain and remained unrestricted six months after discharge. Discussion: This case highlights the effectiveness of combining individualized stroke analysis with evidenced based rehabilitation for an individual with SD and SP. The SER/IRA provided insight into the subject's movement quality, guided treatment progression, augmented rehabilitation, and facilitated collaboration between the physical therapist and coach. Such tools may help promote long-term pain reduction, expedite return-to-play, and optimize performance for players with SP and/or SD. Level of Evidence: Level 4.