Synopsis There is a growing body of literature associating abnormal scapular positions and motions, and, to a lesser degree, clavicular kinematics with a variety of shoulder pathologies. The purpose of this manuscript is to (1) review the normal kinematics of the scapula and clavicle during arm elevation, (2) review the evidence for abnormal scapular and clavicular kinematics in glenohumeral joint pathologies, (3) review potential biomechanical implications and mechanisms of these kinematic alterations, and (4) relate these biomechanical factors to considerations in the patient management process for these disorders. There is evidence of scapular kinematic alterations associated with shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, glenohumeral instability, adhesive capsulitis, and stiff shoulders. There is also evidence for altered muscle activation in these patient populations, particularly, reduced serratus anterior and increased upper trapezius activation. Scapular kinematic altera...

The association of scapular kinematics and glenohumeral joint pathologies

The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. The areas covered included the scapula and shoulder injury, the scapula and sports participation, clinical evaluation and interventions and known outcomes. Major conclusions were (1) scapular dyskinesis is present in a high percentage of most shoulder injuries; (2) the exact role of the dyskinesis in creating or exacerbating shoulder dysfunction is not clearly defined; (3) shoulder impingement symptoms are particularly affected by scapular dyskinesis; (4) scapular dyskinesis is most aptly viewed as a potential impairment to shoulder function; (5) treatment strategies for shoulder injury can be more effectively implemented by evaluation of the dyskinesis; (6) a reliable observational clinical evaluation method for dyskinesis is available and (7) rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive shoulder rehabilitation programme.

https://bjsm.bmj.com/content/bjsports/47/14/877.full.pdf

Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’

The scapula serves many roles in order for proper shoulder function to occur. These roles include providing synchronous scapular rotation during humeral motion, serving as a stable base for rotator cuff activation and functioning as a link in the kinetic chain. Each role is vital to proper arm function and can only occur when the anatomy around the shoulder is uncompromised. The presence of bony and soft tissue injury as well as muscle weakness and inflexibility can alter the roles of the scapula and alter scapular resting position and/or dynamic motion. This altered scapular position/movement has been termed 'scapular dyskinesis'. Although it occurs in a large number of shoulder injuries, it appears that scapular dyskinesis is a non-specific response to a painful condition in the shoulder rather than a specific response to certain glenohumeral pathology. The presence or absence of scapular dyskinesis needs to be determined during the clinical examination. An examination consisting of visual inspection of the scapular position at rest and during dynamic humeral movements, along with the performance of objective posture measurements and scapular corrective maneuvers, will help the clinician ascertain the extent to which the scapula is involved in the shoulder injury. Treatment of scapular dyskinesis should begin with optimised anatomy and then progress to the restoration of dynamic scapular stability by strengthening of the scapular stabilisers utilising kinetic chain-based rehabilitation protocols.

https://bjsm.bmj.com/content/bjsports/44/5/300.full.pdf

Current concepts: scapular dyskinesis

https://www.uhasselt.be/Documents/UHasselt/initiatieven/2012/schouderklachten/2-Anat-Pathokinesiol-Pathofysiol/2-A1-Shoulder-Seitz-Mechanism%20of%20rotat%20cuff%20tendinop-intrins-extrins%20(Rev)-Clin%20Biom-2011.pdf

Mechanisms of rotator cuff tendinopathy: Intrinsic, extrinsic, or both?

BackgroundRestoration of control of dynamic scapular motion by specific activation of the serratus anterior and lower trapezius muscles is an important part of functional rehabilitation. This study evaluated activation of those muscles in specific exercises.HypothesisSpecific exercises will activate key scapular-stabilizing muscles in clinically significant amplitudes and patterns.Study DesignControlled laboratory study.MethodsMuscle activation amplitudes and patterns were evaluated in the serratus anterior, upper trapezius, lower trapezius, anterior deltoid, and posterior deltoid muscles with electromyography in symptomatic (n = 18) and asymptomatic (n = 21) subjects as they executed the low row, inferior glide, lawnmower, and robbery exercises.ResultsThere were no significant differences in muscle activation amplitude between groups. Muscle activation was moderate across all of the exercises and varied slightly with the specific exercise. The serratus anterior and lower trapezius were activated between ...

Electromyographic Analysis of Specific Exercises for Scapular Control in Early Phases of Shoulder Rehabilitation

Effect of scapular protraction and retraction on isometric shoulder elevation strength

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Effect of scapular protraction and retraction on isometric shoulder elevation strength