Scapular Dyskinesis

Have you noticed shoulder pain, a strange flap of your shoulder blade when you lift your arm, or difficulty with arm movements overhead? These may be signs that you’re dealing with a condition called scapular dyskinesis, a subtle but important cause of shoulder dysfunction.

Our fellowship-trained shoulder and sports medicine surgeon, Dr. Benjamin W. Szerlip, in Austin, Texas, and our team are here to walk you through what this condition is, how it shows up, and what you can do about it. If you’ve been struggling with shoulder movement or persistent “shoulder pain,” we encourage you to reach out to our practice to explore your options.

Topic at a Glance

Scapular dyskinesis is an abnormal pattern of scapular motion or scapula position during arm movement or rest.
Key signs include shoulder pain, winging or medial border prominence of the shoulder blade, weakness with arm elevation, and snapping or popping during shoulder movement.
Treatment focuses on physical therapy exercises, optimized scapular positioning, strengthening of scapular stabilizers and the rotator cuff, and, in rare cases, surgical intervention.

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What Patients Are Saying

“After a bad fall from a ladder and seeing two other doctors, I was referred to Dr. Szerlip. He was able to repair the breaks in my arm and shoulder. Four months post surgery and I have full use of my arm and shoulder. THANK YOU DR. SZERLIP!!” — Patricia J.

What is Scapular Dyskinesis?

The term scapular dyskinesis refers to an alteration in the normal motion (kinematics) of the scapula (shoulder blade) during arm movements or its resting scapula position. In simpler terms, your shoulder blade is supposed to move in a coordinated way as you raise your arm (arm elevation) and perform tasks. When that scapular motion or the position of your scapula is abnormal, we call it scapular dyskinesis.

The scapula plays an essential role in shoulder joint mechanics. It supports the head of the humerus (upper arm bone) and works with your rotator cuff muscles and other scapular stabilizers to ensure smooth shoulder movement.

When scapular dyskinesis is present, you might experience disruption of the scapulohumeral rhythm (the coordinated motion between scapula and humerus), which may lead to shoulder dysfunction or contribute to shoulder pathology such as subacromial impingement syndrome.

What Are the Signs of Scapular Dyskinesis?

Here are some of the hallmark signs of scapular dyskinesis:

Shoulder pain around the shoulder blade or scapula, especially with arm elevation (raising your arm) or overhead arm movements.
A visible prominence of the medial border of the shoulder blade is sometimes described as “winging” of the shoulder blade. In other words, the shoulder blade may appear to stick out more than the other side.
Changes in scapular motion. This may include diminished upward rotation, reduced posterior tilt of the scapula, or excessive medial translation of the scapula during arm elevation.
Feeling of weakness or fatigue in the arm or shoulder when doing repetitive overhead tasks or arm movements.
A snapping, popping or grinding sensation with shoulder movement as the scapula moves abnormally.

These signs warrant evaluation, especially if you’ve been dealing with shoulder pain or dysfunction that hasn’t resolved.

What Causes Scapular Dyskinesis?

Scapular dyskinesis can arise from various underlying issues. Some of the common causes and risk factors include:

Muscle weakness or imbalance in the scapular stabilizers (such as the serratus anterior, lower and upper trapezius) or in the rotator cuff muscles (which help stabilize the shoulder joint).
Nerve injury or dysfunction that impairs the muscles controlling scapular motion.
Repetitive overhead or throwing activities. Athletes such as swimmers, pitchers, and volleyball players are at higher risk because of the demands on arm elevation and scapular motion.
Poor posture, thoracic spine issues, or altered biomechanics (such as from a spinal kyphosis) that change scapula position and motion.
Shoulder pathology itself, such as subacromial impingement syndrome, rotator cuff injury, or instability in the shoulder joint, can either lead to scapular dyskinesis or be exacerbated by it.

In short, when the mechanics of the shoulder blade are disrupted, it can affect the entire shoulder complex and lead to more serious issues if unaddressed.

How is Scapular Dyskinesis Diagnosed?

Diagnosing scapular dyskinesis primarily relies on careful physical examination of the scapular motion and position during arm movements and rest. According to the American Academy of Orthopaedic Surgeons, abnormalities in the resting position of the scapula or its motion as the arm moves can indicate the condition.

Some specific tests include:

Scapular Retraction Test: The examiner will test arm strength by pushing down on your extended arm. The test is repeated while manually retracting the scapula. Increased strength indicates your muscles are not strong enough to raise your arm.
Scapular Assistance Test: The clinician assists the scapula through its correct motion (for instance, upward rotation and posterior tilt) while the patient elevates the arm; improvement in symptoms suggests a scapular component.

Imaging (X-ray, MRI) is not typically needed to make the diagnosis of scapular dyskinesis itself, though it may be used to rule out other shoulder or scapular joint pathologies.

What Treatment Options Are Available for Scapular Dyskinesis?

Treatment of scapular dyskinesis generally emphasizes non-surgical interventions, with a major focus on physical therapy. Here’s how we approach it:

Physical therapy exercises focused on strengthening the scapular stabilizer muscles and the rotator cuff muscles
Postural correction and scapular positioning education.
Activity modification.
Pain management using NSAIDs.
Surgery is rarely needed and only if an injury is the cause of shoulder dyskinesia.

As our practice under Dr. Szerlip emphasizes, restoring good scapular kinetics and normal scapular motion is essential because a well-positioned shoulder blade enables healthy shoulder joint mechanics and proper function of your rotator cuff muscles during arm elevation.

Can Scapular Dyskinesis Be Prevented?

Yes, while not all instances are preventable (especially after trauma or nerve injury), many risk factors are modifiable. You can take preventive steps such as:

Incorporating proper warm-up before overhead activities, emphasizing scapular movement and stabilization.
Building and maintaining strength in your scapular stabilizers and rotator cuff muscles, even if you’re not currently injured.
Ensuring good scapular positioning in daily life, practicing scapular retraction, avoiding slumped posture, and maintaining good thoracic spine alignment.
Be mindful of repetitive overhead work or sports, reducing excessive load, and monitoring fatigue.
If you’re an athlete (swimmer, baseball pitcher, volleyball player), working with a coach or therapist to ensure correct scapular kinematics and arm elevation mechanics is part of your training approach.

By paying attention to your shoulder blade motion and scapular positioning early, you can reduce the risk of developing shoulder pain and dysfunction tied to scapular dyskinesis.

Schedule an Evaluation for Scapular Dyskinesis in Austin, Texas

If you’re experiencing shoulder pain, feeling like your shoulder blade isn’t moving right, or you suspect your shoulder dysfunction may be tied to abnormal scapular motion, don’t wait. Our team at Dr. Benjamin W. Szerlip’s practice in Austin is ready to help you evaluate your shoulder, identify whether scapular dyskinesis is involved, and build a personalized treatment plan including physical therapy and guided care. Contact us today!

Can scapular dyskinesis cause rotator cuff tears?

Yes. Abnormal scapular position or motion can alter how your shoulder joint functions and increase stress on the rotator cuff muscles. Scapular dyskinesis may contribute to rotator cuff tendinopathy or tears over time.

How long does treatment for scapular dyskinesis take?

It varies depending on severity and underlying cause, but many patients respond to physical therapy within 4-8 weeks of consistent rehab and activity modification.

Do I always see visible “winging” of the shoulder blade if I have scapular dyskinesis?

Not always. Some cases are subtle and may only show abnormal scapular motion during arm elevation rather than obvious winging at rest.

Are there special tests my doctor will perform?

Yes, tests such as the scapular retraction test and scapular assistance test help evaluate scapular motion and how the scapula contributes to shoulder pain or dysfunction.

Is surgery common for scapular dyskinesis?

No, surgical treatment is relatively uncommon and usually reserved for cases with identifiable structural anomalies or nerve injury that cannot be managed conservatively. Most cases improve with physical therapy and rehab.

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