Experiencing shoulder blade pain? It might be scapular dyskinesis.

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.

If you’re experiencing shoulder blade pain, pain between your shoulder blades or pain under your shoulder blades, it may be due to scapular dysfunction – officially known as scapular dyskinesis.

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:

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.

These musculoskeletal issues are often attributed to overuse, repetitive motions (such as throwing or serving) and poor overhead movement mechanics. Scapular dyskinesis can also be caused by injuries to the nerves that supply these muscles.

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 tests the strength – or lack thereof – in your shoulder and scapular muscles to determine if muscle weakness is a contributing factor to your shoulder pain and abnormal scapular positioning and/or motion.

Scapular Assistance Test (SAT)

The scapular assistance test helps determine if your muscles are strong enough to raise your arm on the affected side. Your shoulder doctor will apply pressure to your shoulder blade, helping it move up upward as you raise your arm. If your range of motion increases and your symptoms decrease, it is a good indication that the muscles are too weak for proper function.

Scapular Retraction Test

The scapular retraction test helps determine if scapular dyskinesis is present. Your doctor will push down on your extended arm to test its strength. Next, he or she will manually move the scapula into a retracted position and repeat the strength test. If your strength improved with the scapular manipulation, you most likely have scapular dyskinesis.

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.


I have had offered on intense scapular pain since severe of whiplash injury at age 18. It has recently progressed worse and worse pain is almost 10/10 along with Myriad of other symptoms. I feel like there is a pinched artery, vein, or nerve somewhere in the scapular area neck or left side vertebral leading to scapula. Possibly the suprascapular nerve or dorsal scapular nerve? Or arteries? I cannot be up right or the pain is so severe and I get a myriad of other symptoms causing me to be bedridden.


    Hi Sheena,
    Sorry to hear you’re in so much pain. The best way to proceed would be to get an MRI to evaluate for a pinched nerve. If you have not had a recent x-ray, it would be a good idea to get that as well to rule out any musculoskeletal injuries or arthritis. To get an MRI you will need to get an order from either your primary care provider or a sports medicine or orthopedic doctor. If you do not have a primary care provider, we have sports medicine and orthopedic doctors at our office that would be happy to help you. Simply call (435)615-8822 and we will get you taken care of! Wishing you the best of luck with your recovery.


    I have p. M. R so am use to pain in neck and shoulder s but had to move house and packed and lifted and did stuff I would not do because of my p.m.r .now I am in agony with pain across my upper back chronic pain all down shoulder blades and so sore it hurts to do any thing only get restspite when asleep then afraid to move on waking up it hurts so sore what is your morning like on wake up ..


      Hi Marian,
      If you are in extreme pain I highly recommend getting into a doctor asap for effective diagnosis and treatment. We unfortunately do not have any back doctors that are taking new patients at the moment. So I would recommend reaching out to Dr. Craig Davis with Granger Medical. His office phone number is (801)569-5520. Wishing you a speedy recovery!


    I feel this same thing..i had a compression fracture in my upper back…it was 20 yrs ago and the pain is just as bad now than then …


Thank you for this information…. I have been sick with this disease for years… and the diagnosis was different for every doctor I go to… I want to know the exercises required to relieve shoulder pain and trigger points.


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