Scapular Dyskinesis

By: Natalie Valdez, PT, DPT, SMTC, CSCS 

The scapula (shoulder blade) is the core of the upper body and is extremely important. Our scapula combined with our shoulder (Glenohumeral) joint contributes to our ability to raise our arm a full 180 degrees overhead. In general, there is a 2:1 ratio of humeral motion to scapular motion. When we raise our arm overhead, our scapula should upwardly rotate, posteriorly tilt, and has variable internal/external rotation in order to maximize our shoulder range of motion and available subacromial space. The muscles that connect and provide a role in scapular motion include the upper/middle/lower trapezius, rhomboids, serratus anterior, and the latissimus dorsi. 

What is Scapular Dyskinesis?

Scapular dyskinesis is often referred to as altered scapular motion during upper limb tasks.This has been identified in many patient populations including shoulder impingement, rotator cuff tears, shoulder instability, adhesive capsulitis, and neck pain. This shows that the pain or dysfunction at your shoulder may not actually be caused by your shoulder, but your scapula. 

Symptoms of Scapular Dyskinesis

• Aberrant motion/jerkiness with overhead motions 

• “Winging” of scapula

• Shoulder blade stiffness & discomfort 

• Pain along scapula or shoulder 

Studies have shown that not everyone with scapular dyskinesis will have pain (Rossi, 2018). Although not everyone will have pain, athletes with scapular dyskinesis have a 43% greater risk of developing shoulder pain than those without scapular dyskinesis due to the increase in reliance on their scapula to function properly at a higher level (Hickey, 2017). 

Treatment 

Treatment is directed at managing the underlying cause and restoring normal scapular muscle activation patterns. If the underlying cause is due to a lack of soft tissue flexibility, then physical therapy will focus on manual stretching, home stretching, soft-tissue techniques (cupping therapy), manual mobilizations, and mobilization with movement. Flexibility deficits have been found to lead to a shoulder impingement diagnosis and chronic shoulder pain in overhead athletes. If the underlying cause is due to a lack of muscle performance, then physical therapy will focus on neuromuscular coordination and strength training. The serratus anterior muscle and the lower trapezius are the most important muscles to strengthen due to their action of upward rotation for the scapula. (AAOS, 2003)

Scapular rehabilitation with physical therapy has been found to be important at increasing the strength and recruitment of scapular muscles, increasing strength in shoulder muscles, and improving functional outcomes and patient satisfaction. 

If you, or someone you know is dealing with pain of any kind in the shoulder/scapula region please feel free to reach out to us, we are here to help! 

Email: info@motionrxdfw.com

Phone: 469-967-1278

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