Evaluation and Management of Scapular Dyskinesis in Overhead Athletes

  • W. Ben Kibler
  • Aaron SciasciaEmail author
Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Injuries in Overhead Athletes


Purpose of Review

This review will outline scapular function in throwing, discuss scapular dyskinesis as an impairment of function that can be associated with throwing injuries and altered performance, and present an algorithm that encompasses guidelines for evaluation and can serve as a basis for treatment.

Recent Findings

Optimal scapular function is integral to optimal shoulder function. Multiple roles of the scapula in arm function and throwing have been identified while scapular dysfunction continues to be associated with various shoulder pathologies. Although scapular motion alterations may be common in overhead athletes, various reports have shown that identification and management of the alterations can result in improved rehabilitation and performance outcomes.


Baseball throwing occurs as the result of integrated, multisegmented, sequential joint motion, and muscle activation within the kinetic chain. The scapula is a key component link within the chain through its function to maximize the scapulohumeral rhythm and efficient throwing mechanics. Evaluation and management beginning with the scapula can produce improved outcomes related to shoulder pathology in overhead athletes.


Scapula Scapular dyskinesis Kinetic chain Overhead athlete 


Compliance with Ethical Standards

Conflict of Interest

W. Ben Kibler and Aaron Sciascia receive royalties from Springer Publishing for co-editing 2 textbooks.


  1. 1.
    Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;52:102–10. Scholar
  2. 2.
    Kibler WB, Ludewig PM, McClure PW, Uhl TL, Sciascia AD. Scapula summit 2009. J Orthop Sports Phys Ther. 2009;39(11):A1–A13. Scholar
  3. 3.
    Warner JJP, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. Clin Orthop Relat Res. 1992;285(191):199.Google Scholar
  4. 4.
    Paletta GA, Warner JJP, Warren RF, Deutsch A, Altchek DW. Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tears. J Shoulder Elb Surg. 1997;6:516–27.CrossRefGoogle Scholar
  5. 5.
    Weiser WM, Lee TQ, McQuade KJ. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med. 1999;27:801–5. Scholar
  6. 6.
    Kibler WB, Uhl TL, Maddux JWQ, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elb Surg. 2002;11:550–6. Scholar
  7. 7.
    Mihata T, Jun BJ, Bui CN, Hwang J, McGarry MH, Kinoshita M, et al. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am. 2012;94(17):1576–83. Scholar
  8. 8.
    Sarkar S, Seeley S, Beranek K, Blom K, Braman JP, Ludewig PM, editors. Rotator cuff proximity to potential impinging structures during clinical impingement tests. IXth Conference of the International Shoulder Group; 2012; Wales, UK: Aberystwyth University.Google Scholar
  9. 9.
    McClure PW, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis: part 1: reliability. J Athl Train. 2009;44(2):160–4. Scholar
  10. 10.
    Tate AR, McClure PW, Kareha S, Irwin D, Barbe MF. A clinical method for identifying scapular dyskinesis: part 2: validity. J Athl Train. 2009;44(2):165–73. Scholar
  11. 11.
    Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the "scapula summit". Br J Sports Med. 2013;47:877–85. Scholar
  12. 12.
    Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240–8. Scholar
  13. 13.
    Kibler WB. The role of the scapula in athletic function. Am J Sports Med. 1998;26:325–37. Scholar
  14. 14.
    Kibler WB, Sciascia AD, Dome DC, Hester PW, Jacobs C. Clinical utility of new and traditional exam tests for biceps and superior glenoid labral injuries. Am J Sports Med. 2009;37(9):1840–7. Scholar
  15. 15.
    McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train. 2000;35(3):329–37.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39(4):866–73. Scholar
  17. 17.
    Kibler WB, Press J, Sciascia AD. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98. Scholar
  18. 18.
    Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80(3):276–91.PubMedGoogle Scholar
  19. 19.
    Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90–104. Scholar
  20. 20.
    Ogston JB, Ludewig PM. Differences in 3-dimensional shoulder kinematics between persons with multidirectional instability and asymptomatic controls. Am J Sports Med. 2007;35:1361–70. Scholar
  21. 21.
    Timmons MK, Thigpen CA, Seitz AL, Karduna AR, Michener LA. Scapular kinematics and subacromial impingement syndrome: a meta-analysis. J Sport Rehabil. 2012;21(4):354–70.CrossRefGoogle Scholar
  22. 22.
    Green RA, Taylor NF, Watson L, Ardern C. Altered scapular position in elite young cricketers with shoulder problems. J Sci Med Sport. 2013;16(1):22–7. Scholar
  23. 23.
    Reuther KE, Thomas SJ, Tucker JJ, Yannascoli SM, Caro AC, Vafa RP, et al. Scapular dyskinesis is detrimental to shoulder tendon properties and joint mechanics in a rat model. J Orthop Res. 2014;32(11):1436–43. Scholar
  24. 24.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20. Scholar
  25. 25.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641–61.CrossRefGoogle Scholar
  26. 26.
    Reinold MM, Wilk KE, Macrina LC, Sheheane C, Dun S, Fleisig GS, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36(3):523–7. Scholar
  27. 27.
    Kibler WB, Sciascia AD, Thomas SJ. Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing. Sports Med Arthrosc Rev. 2012;20(1):34–8. Scholar
  28. 28.
    Kibler WB, Sciascia AD, Moore SD. An acute throwing episode decreases shoulder internal rotation. Clin Orthop Relat Res. 2012;470:1545–51. Scholar
  29. 29.
    Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34:385–91. Scholar
  30. 30.
    Laudner KG, Myers JB, Pasquale MR, Bradley JP, Lephart SM. Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 2006;36(7):485–94. Scholar
  31. 31.
    Laudner KG, Stanek JM, Meister K. Differences in scapular upward rotation between baseball pitchers and position players. Am J Sports Med. 2007;35:2091–5. Scholar
  32. 32.
    Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2009;25(1):40–5. Scholar
  33. 33.
    Shields E, Behrend C, Beiswenger T, Strong B, English C, Maloney M, et al. Scapular dyskinesis following displaced fractures of the middle clavicle. J Shoulder Elb Surg. 2015;24(12):e331–6. Scholar
  34. 34.
    McKee MD, Pedersen EM, Jones C, Stephen DJG, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35–40. Scholar
  35. 35.
    Oki S, Matsumura N, Iwamoto W, Ikegami H, Kiriyama Y, Nakamura T, et al. Acromioclavicular joint ligamentous system contributing to clavicular strut function: a cadaveric study. J Shoulder Elb Surg. 2013;22(10):1433–9. Scholar
  36. 36.
    Kuhn J, Plancher K, Hawkins R. Scapular winging. J Am Acad Orthop Surg. 1995;3:319–25.CrossRefGoogle Scholar
  37. 37.
    Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012;20(6):364–72. Scholar
  38. 38.
    Kibler WB, Kuhn JE, Wilk KE, Sciascia AD, Moore SD, Laudner KG, et al. The disabled throwing shoulder - spectrum of pathology: 10 year update. Arthroscopy. 2013;29(1):141–61. Scholar
  39. 39.
    Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior Labral tears in professional baseball players. Am J Sports Med. 2014;42(5):1155–60. Scholar
  40. 40.
    Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine W, et al. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med. 2010;38(7):1456–61. Scholar
  41. 41.
    Kibler WB. Management of the scapula in glenohumeral instability. Tech Should Elbow Surg. 2003;4(3):89–98. Scholar
  42. 42.
    Burkhead WZ, Rockwood CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am. 1992;74-A(6):890–6.CrossRefGoogle Scholar
  43. 43.
    Wilk KE, Macrina LC, Reinold MM. Non-operative rehabilitation for traumatic and atraumatic glenohumeral instability. N Am J Sports Phys Ther. 2006;1(1):16–31.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005;35(4):227–38. Scholar
  45. 45.
    Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010;44:319–27. Scholar
  46. 46.
    Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elb Surg. 2009;18:138–60. Scholar
  47. 47.
    Sciascia A, Karolich D. A comprehensive approach for non-operative treatment of the rotator cuff. Curr Phys Med Rehabil Rep. 2013;1(1):29–37. Scholar
  48. 48.
    Sahara W, Sugamoto K, Murai M, Yoshikawa H. Three-dimensional clavicular and acromioclavicular rotations during arm abduction using vertically open MRI. J Orthop Res. 2007;25:1243–9. Scholar
  49. 49.
    Kibler WB, Sciascia AD, Morris BJ, Dome DC. Treatment of symptomatic acromioclavicular joint instability by a docking technique: clinical indications, surgical technique, and outcomes. Arthroscopy. 2017;33:696–708. Scholar
  50. 50.
    Kibler WB, Sciascia AD. Kinetic chain contributions to elbow function and dysfunction in sports. Clin Sports Med. 2004;23(4):545–52.CrossRefGoogle Scholar
  51. 51.
    Tripp BL, Boswell LL, Gansneder BM, Shultz SJ. Functional fatigue decreases three-dimensional multi-joint position reproduction acuity in the overhead throwing athlete. J Athl Train. 2004;39(4):316–20.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Tripp B, Uhl TL, Mattacola CG, Srinivasan C, Shapiro R. Functional multijoint position reproduction acuity in overhead athletes. J Athl Train. 2006;41(2):146–53.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Ebaugh DD, McClure PW, Karduna AR. Effects of shoulder muscle fatigue caused by repetitive overhead activities on scapulothoracic and glenohumeral kinematics. J Electromyogr Kinesiol. 2006;16:224–35. Scholar
  54. 54.
    Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2014;42:2075–81. Scholar
  55. 55.
    Itami Y, Mihata T, McGarry MH, Lin CC, Patel NA, Kantor A, et al. Effect of increased scapular internal rotation on glenohumeral external rotation and elbow valgus load in the late cocking phase of throwing motion. Am J Sports Med. 2018;46:3182–8. Scholar
  56. 56.
    Hirashima M, Kudo K, Watarai K, Ohtsuki T. Control of 3D limb dynamics in unconstrained overarm throws of different speeds performed by skilled baseball players. J Neurophysiol. 2007;97(1):680–91. Scholar
  57. 57.
    Hirashima M, Yamane K, Nakamura Y, Ohtsuki T. Kinetic chain of overarm throwing in terms of joint rotations revealed by induced acceleration analysis. J Biomech. 2008;41:2874–83. Scholar
  58. 58.
    Sciascia A, Cromwell R. Kinetic chain rehabilitation: a theoretical framework. Rehabil Res Pract. 2012;2012:1–9. Scholar
  59. 59.
    Sciascia A, Monaco M. When is the Patient truly ‘ready to return’, a.k.a. kinetic chain homeostasis. In: Kelly IV JD, editor. Elite techniques in shoulder arthroscopy: new frontiers in shoulder preservation. Switzerland: Springer; 2016. p. 317–327.Google Scholar
  60. 60.
    Sciascia AD, Thigpen CA, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc Rev. 2012;20(1):16–21. Scholar
  61. 61.
    Bouisset S, Zattara M. A sequence of postural movements precedes voluntary movement. Neurosci Lett. 1981;22:263–70.CrossRefGoogle Scholar
  62. 62.
    Hodges PW, Richardson CA. Feedforward contraction of transversus abdominus is not influenced by the direction of arm movement. Exp Brain Res. 1997;114:362–70.CrossRefGoogle Scholar
  63. 63.
    Lippitt S, Matsen Iii FA. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8.Google Scholar
  64. 64.
    Lippitt S, Vanderhooft JE, Harris SL, Sidles JA, Harryman Ii DT, Matsen Iii FA. Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elb Surg. 1993;2(1):27–35. Scholar
  65. 65.
    Smith J, Kotajarvi BR, Padgett DJ, Eischen JJ. Effect of scapular protraction and retraction on isometric shoulder elevation strength. Arch Phys Med Rehabil. 2002;83:367–70. Scholar
  66. 66.
    Smith J, Dietrich CT, Kotajarvi BR, Kaufman KR. The effect of scapular protraction on isometric shoulder rotation strength in normal subjects. J Shoulder Elb Surg. 2006;15:339–43. Scholar
  67. 67.
    Kibler WB, Sciascia AD, Dome DC. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med. 2006;34(10):1643–7. Scholar
  68. 68.
    Tate AR, McClure P, Kareha S, Irwin D. Effect of the scapula reposition test on shoulder impingement symptoms and elevation strength in overhead athletes. J Orthop Sports Phys Ther. 2008;38(1):4–11. Scholar
  69. 69.
    De May K, Danneels L, Cagnie B, Huyghe L, Seyns E, Cools AM. Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography. J Orthop Sports Phys Ther. 2013;43(1):3–10. Scholar
  70. 70.
    Ellenbecker TS, Manske R, Davies GJ. Closed kinetic chain techniques of the upper extremities. Orthop Phys Ther Clin N Am. 2000;9(2):219–29.Google Scholar
  71. 71.
    Kibler WB, Livingston B. Closed-chain rehabilitation for upper and lower extremities. J Am Acad Orthop Surg. 2001;9(6):412–21.CrossRefGoogle Scholar
  72. 72.
    Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med. 2008;36(9):1789–98. Scholar
  73. 73.
    De May K, Danneels L, Cagnie B, Cools A. Are kinetic chain rowing exercises relevant in shoulder and trunk injury prevention training? Br J Sports Med. 2011;45(4):320.Google Scholar
  74. 74.
    Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson Ii CD, Harker P, et al. Loss of internal rotation and the correlation to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329–35. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Shoulder Center of KentuckyLexington ClinicLexingtonUSA
  2. 2.Department of Exercise and Sport ScienceEastern Kentucky UniversityRichmondUSA

Personalised recommendations