It has been proposed that altered scapular muscle function can contribute to alterations in shoulder kinematics, which often lead to SD and are frequently associated with other shoulder pathologies, such as RC tears, labrum tears, impingement syndrome, and glenohumeral joint instability. However, whether SD leads to the development of these diseases or is a consequence has yet to be clarified. Changes in scapular kinematics can be attributed not only to altered scapular recruitment patterns (e.g., altered serratus anterior muscle activity) or muscle performance (e.g., force imbalance in the upper and lower trapezius muscles) but also to flexibility deficits in the soft tissue surrounding the scapula, which may restrict normal scapular movement during daily activities and sport- specific movements. Although many studies have investigated the optimal management method, to date, there is no consensus. Conservative approaches involve not only physiotherapy but also other techniques, such as extracorporeal shockwave therapy.

This is a prospective, double-blinded, placebo-controlled randomised study. The closed envelop randomization method will be used for the randomization of the patients who will be also blinded to group allocation. The patients will be allocated into two groups:Group I: will be exposed to rESWT once weekly for one month Group II: will be exposed to ShamrESWT once weekly for one month. During the study period, stretching exercises will be similarly given for both groups.

Inclusion Criteria:

• This study included 100 patients with scapular dyskinesis. The patients were divided into 2 groups: one group was treated with ESWT and routine rehabilitation, and the second group was treated with routine rehabilitation only. Adult patients with scapular dyskinesia who exhibited signs of dyskinesia for at least 6 months before enrolment in the study will be selected.

Exclusion Criteria:

1. History of shoulder or thorax trauma or surgery.
2. The back pain involved the cervical spine and thoracic spine.
3. Participants with neurologic deficits
4. history of inflammatory conditions such as ankylosing spondylitis

4- Certain situations where shockwave therapy is not recommended. These include:

Absolute contraindications:

• Active infection (i.e., osteomyelitis)
• Malignant tumors, particularly at the treatment site (focused shockwave)
• Pregnancy

Relative Contraindications:

• The brain or nerve in the treatment focus
• Treatment focused on the lungs or pleura
• Significant coagulopathy (increased risk of bleeding, such as haemophilia)
• Epiphyseal plate in treatment focus

Important considerations:

• Cardiac pacemakers or other implantable devices
• Current nonsteroidal anti-inflammatory drug use
• Current anticoagulation use
• Recent corticosteroid injections (receiving a steroid injection into the area to be treated within the previous 12 weeks).

Plan to Share IPD: "Yes" Plan Description: "Data obtained through this study may be provided to qualified researchers with academic interest in scapular dyskinesis. Data or samples shared will be coded, with no PHI included. Approval of the request and execution of all applicable agreements (i.e., a material transfer agreement) are prerequisites to the sharing of data with the requesting party.

Results will be published by the investigators in academic journal.

Data requests can be submitted starting 9 months after article publication and the data will be made accessible for up to 24 months. Extensions will be considered on a case-by-case basis

Access to trial IPD can be requested by qualified researchers engaging in independent scientific research and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA).

This is a prospective, double-blinded, placebo-controlled randomised study. The closed envelop randomization method will be used for the randomization of the patients who will be also blinded to group allocation. The assessments will be done by the first physiatrist (A), who will not be involved in patients' sessions. The randomization will be performed by the second physiatrist (B ) who will not be involved in patients'assessment and ESWT sessions . ESWT Sessions for both groups will be will be carried out by the third physiatrist (C ) who will not take part in the assessments or patients'randomization . Both (C) and (A) were blinded to group allocation.

The patients will be allocated into two groups:

Group I: will be exposed to rESWT once weekly for one month Group II: will be exposed to ShamrESWT once weekly for one month. During the study period, stretching exercises will be similarly given for both groups.