What Is Scapular Dyskinesis?

Scapular dyskinesis refers to abnormal movement or positioning of the scapula (shoulder blade) during shoulder motion. The scapula plays a critical role in shoulder function. It acts as the stable base upon which the arm and neck moves, providing both mobility and stability.

In normal shoulder function, the scapula and shoulder joint must work together for full range of motion. This coordinated pattern is called scapulohumeral rhythm. When this rhythm is disrupted, due to tight muscles, joint dysfunctions in the neck, shoulder or ribs, the scapula may move too early or too late. This altered pattern is called scapular dyskinesis.

This is typically not due to a specific injury or trauma (though it can be!), but rather a movement impairment and muscle imbalance that may happen over time. It is often caused by repetitive activities or postural habits and compensations. It is important to identify these movement dysfunctions early on to prevent secondary shoulder injuries.

Several factors can contribute to abnormal scapular movement patterns. Muscle imbalances such as tight chest (pectoral) muscles can pull the scapula forwards, or tight posterior shoulder muscles can pull the scapula laterally (out to the side). Similarly, weak muscles in the rotator cuff or mid back can “allow” these tight muscles to dominate. Poor postural positions can be a factor, as we tend to round our shoulders forward and have a head forward posture. This can alter the scapula alignment with adapted muscle compensations. Shoulder injuries, tendonitis, labral tears, and muscle impingements can both CAUSE poor scapula control or BE CAUSED by poor scapula control. Neck joint dysfunctions or osteoarthritis in the neck can cause nerve impingements that may lead to a neuropathy to the shoulder muscles. Most shoulder and scapular muscles are innervated (supplied nutrition) by the nerve roots exiting C5 – C7 in our lower neck. When our muscles, tendons, and connective tissue are not getting sufficient nutrition and blood flow, they can become weak, tight, and painful. This may also be associated with referred pain down the arm, such as pins and needles, numbness, achiness or shooting pain,

Having said all that, many observed scapula dyskinesis cases can be normal, healthy and pain free! Just because you have some asymmetry in your body, does not always mean there will be pain. An MRI study of healthy adults and seniors found that 98% of persons with no neck pain had evidence of “degenerative changes” in cervical discs. For most people, joint degeneration / arthritis and mild disc bulges are part of the NORMAL aging process (Advanced Physical Therapy Education Institute (APTEI), 2015). Similarly in the shoulder, rotator cuff abnormalities are nearly universal after age 40 and should be considered normal age-related changes. Another APTEI study showed that for those over 60 years, MRI studies showed that 50% of individuals with no shoulder pain or injury, had rotator cuff tears on their MRI they did not know about. The point being – what results show on X-rays and MRI tests are not necessarily associated with your pain!

When shoulder and scapular related issues do become a problem, some signs you may notice are pain with overhead activity, decreased shoulder strength, fatigue, clicking sensations, decreased range of motion or visible “winging” (lifting) of the shoulder blades. In more serious cases, after illness, surgery, or trauma – if you notice marked muscle wasting (atrophy), obvious/ drastic asymmetry, sudden onset muscle weakness, or symptoms worsening quickly – this may indicate a more serious nerve lesion and should be investigated promptly.

Diagnosis is primarily clinical. A physiotherapist observes scapular motion during dynamic movements such as arm elevation or push-ups. They assess posture, muscle activation patterns, and strength deficits. Sometimes imaging may be used to rule out other shoulder pathologies.

The goal of treatment is to restore proper scapular positioning, strength, and coordination. Targeted exercises may include serratus anterior strengthening (e.g., wall slides, push-up plus), lower trapezius strengthening, scapular retraction drills, rotator cuff strengthening and closed-chain stability exercises. Education on posture and ergonomic adjustments can reduce strain on the shoulder. This may include workstation modifications and movement breaks throughout the day. Manual therapy may be used to improve joint mobility and release tight soft tissues, particularly the pectoralis minor and posterior shoulder structures.

Preventing scapular dyskinesis involves maintaining balanced shoulder strength and good posture. Regular shoulder and upper back strengthening, stretching tight chest and anterior shoulder muscles and taking breaks from prolonged sitting are helpful tips to integrate. Physiotherapy plays a vital role in restoring movement, reducing pain, and improving quality of life.

Jennifer Gordon
(BSc.PT, GunnIMS, AFCI)
Physiotherapist – Bragg Creek Physiotherapy
www.braggcreekphysio.com