Shoulder pain is a common complaint in active and non-active people, alike. Musculoskeletal issues, such as overuse, strains, rotator cuff issues, poor exercise form and even sleeping awkwardly, can all cause pain in and around the shoulder blades. While arthritis, heart and lung conditions, shingles, gallstones and even liver disease can manifest as shoulder blade pain, these conditions are much less common causes of shoulder pain than musculoskeletal issues.

Experiencing pain between, under, or around your shoulder blades could be a sign of scapular dysfunction, also called scapular dyskinesis. This condition occurs when the muscles surrounding your shoulder blades fail to function properly. As a result, you may feel discomfort or pain during movement or rest. Identifying scapular dyskinesis early is essential to prevent further injury.

What is scapular dyskinesis?

Put simply, scapular dyskinesis is the abnormal function or mobility of the scapula (shoulder blade) within the shoulder joint.

The shoulder joint is a ball-and-socket joint made up of three bones: the humerus (upper arm bone) the scapula (shoulder blade) and the clavicle (collarbone). The top of the humerus forms the ball that sits within the glenoid (socket) of the scapula. While a complex system of muscles and tendons – including the rotator cuff – holds this ball-and-socket in place, the scapula acts as an anchor site for multiple muscles around the shoulder. The font of the shoulder blade (acromion) also attaches to the clavicle to create the acromioclavicular (AC) joint.

Scapular Dyskinesis and Common Shoulder Pain Causes

The scapula is designed to move in connection with your arm in order to keep the shoulder’s ball-and-socket joint in proper alignment. If an injury, stress or strain to the muscles or tendons in the shoulder causes weakness or imbalance, the position of the scapula can be affected. This, in turn, can cause limited mobility and shoulder blade pain.

Scapular dyskinesis: the surgeon’s perspective, an article published in the NIH’s US National Library of Medicine, concluded that there are high correlations between specific shoulder injuries and scapular dyskinesis:

• Labral injuries
• Shoulder impingement (also known as swimmer’s shoulder)
• Rotator cuff injuries
• AC joint injures
• Clavicle fractures

In addition to the acute injuries above, musculoskeletal issues – weak, tight or detached muscles that control the scapula – are the most common causes of shoulder blade pain.

Musculoskeletal issues often stem from overuse and repetitive motions, like throwing or serving. Poor overhead movement mechanics are also a contributing factor. Additionally, scapular dyskinesis may result from nerve injuries affecting these muscles. Addressing these causes is crucial for effective treatment and prevention.

Common Symptoms

Typical scapular dyskinesis symptoms include:

• Weakness in the arm on the affected side – including the arm feeling “dead” or “heavy”
• Pain and/or tenderness on and around the shoulder blade, particularly on the inner (medial) edge and at the top of the scapula
• Limited range of motion (unable to raise the arm above shoulder height)
• Unnatural “snapping” or “crunching” sound with shoulder rotation and movement
• Visible “winging” (protrusion) of the shoulder blade
• A drooped shoulder posture on the affected side
• Fatigue with overhead and/or repetitive movements

Scapular Dyskinesis Tests & Diagnosis

An orthopedic shoulder specialist will go over your symptoms, injury history, medical history and he or she will conduct a visual examination to look for tightness, weakness or signs of injury.

Manual Muscle Testing

This test evaluates the strength of your shoulder and scapular muscles. It identifies whether muscle weakness contributes to your shoulder pain. Additionally, it assesses if weakness affects scapular positioning or movement. By examining these factors, you can determine if muscle weakness is impacting your shoulder’s overall function. This thorough evaluation helps pinpoint the root cause of discomfort and abnormal motion.

Scapular Assistance Test (SAT)

The Scapular Assistance Test is essential for evaluating your muscle strength in raising your arm on the affected side. During this test, your shoulder doctor will apply targeted pressure to your shoulder blade. This pressure assists in moving your shoulder blade upward as you raise your arm. If you notice an increased range of motion and reduced symptoms, it indicates that your muscles may be too weak for optimal function. This test helps identify whether muscle weakness is impacting your shoulder’s performance.

Scapular Retraction Test

The scapular retraction test is essential for diagnosing scapular dyskinesis. During the test, your doctor will first apply downward pressure to your extended arm to assess its strength. Then, the doctor will manually move the scapula into a retracted position. After repositioning the scapula, the strength test is repeated. If your arm’s strength improves with this adjustment, it is highly likely that you have scapular dyskinesis. This test effectively identifies the condition by evaluating changes in strength with scapular manipulation.

Finally, your orthopedic shoulder specialist will order X-rays, a CT scan or an MRI if he or she believes you may have an injury elsewhere in your shoulder or if you have any bony abnormalities on your scapula.

Scapular Dyskinesis Treatment & Surgery

Most cases of scapular dyskinesis can be treated with nonsurgical options, including nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation and physical therapy to strengthen the muscles that move and stabilize the scapula while stretching the muscles that are limiting full scapular mobility.

Scapular dyskinesis typically does not require shoulder surgery. If your condition was caused by a traumatic injury to the joint or surrounding muscles and tissues, your orthopedic shoulder surgeon may recommend surgical options followed by physical therapy.

If you have any questions about scapular dysfunctions, shoulder pain or your shoulder injury, please contact us and we’ll be happy to help.