## 4 Discussion
It remains uncertain whether these observed scapular kinematic differences during complex movements, such as throwing motions, are also detectable during standard arm elevation tests typically constrained to a single plane of arm elevation, as is often assumed in clinical practice. This raises important questions about the efficacy of incorporating athletic overhead functional movement patterns, like those studied here, into the clinical examination of scapular function in athletes. Such an approach may potentially enhance the diagnostic process, guide rehabilitation interventions, and inform return-to-play decisions following a shoulder injury. These considerations warrant further investigation in future research endeavors. A secondary objective of this study was to evaluate whether there were significant differences in the PNF-D2 task between athletes with and without dyskines. This was a preliminary evaluation that could guide future, more comprehensive research. Future studies with extended recruitment periods and larger sample sizes are needed to further investigate the scapular (mal)adaptive movement patterns resulting from repetitive unilateral overhead throwing. Whether altered scapular kinematics is detrimental to shoulder function, poses a risk factor for shoulder injuries and pain, or is just a normal adaptation to chronic throwing exposure is the subject of ongoing debate [1; 2; 32; 33; 34; 35] and conflicting findings [3; 36; 37; 38; 39] in the literature. In our preliminary analysis, we did not observe statistically significant differences in scapular motion between athletes with and without scapular dyskines, as well as non-athletes. On average, any differences between these groups tended to be more pronounced for scapular internal/external rotation (up to \(8.5^{\circ}\)), followed by anterior/posterior tilting (up to \(5.6^{\circ}\)), and were relatively smaller for upward/downward rotation (up to \(4.2^{\circ}\)). Our findings appear to contradict those of a study conducted by [PERSON] et al. [40], which examined 3D scapular orientation in a mixed group of overhead sports athletes, including volleyball, water polo, and swimming. In their research, athletes with scapular dyskines (n = 14), identified using a similar screening method to ours, exhibited, on average, reduced scapular external rotation (\(10.7^{\circ}\), \(p\) = 0.036) at \(90^{\circ}\) of humero-thoracic elevation performed in the sagittal plane (shoulder flexion) compared to athletes without scapular dyskines (n = 11). Intriguingly, our study found fewer differences in scapular motion at the \(90^{\circ}\) angle of humero-thoracic elevation between volleyball players with and without dyskines across all tasks (Figure 3). These disparities between our findings and those of [PERSON] et al. [40] could potentially be attributed to differences in sample characteristics (mixed-sex and overhead sports participants with only apparent dyskinesia [40] vs. male volleyball players with both subtle and apparent dyskinesia in an equal proportion in our study) and task protocols (arm positioning at \(90^{\circ}\) of humero-thoracic elevation [40] vs. continuous arm elevation from rest to full arm elevation in our study). Another study [41] that employed the same method for diagnosing scapular dyskinesis also identified significant differences in scapular orientation among male high school pitchers. In this study, individuals with dyskinesis (n = 15; including five with obvious dyskinesis and 10 with subtle dyskinesis) displayed distinct scapular positioning and motion compared to those with clinically determined normal scapular function (n = 18). Utilizing an optical system to capture 3D scapular kinematics, researchers observed that the pitching arms with scapular dyskinesis exhibited, on average, greater scapular internal rotation (\(3.8^{\circ}\), \(p\) = 0.020, \(d\) = 0.80) compared to the pitching arms of their non-impaired counterparts.