Scapular Dyskinesis in Athletes

  • W. Ben Kibler
  • Aaron Sciascia


The scapula plays multiple key roles in producing normal shoulder and arm function in the overhead throwing motion. Its positions and motions are created and controlled by coordinated patterns of muscle activations and synchronised trunk and arm motions, and are also controlled and constrained by key skeletal components (the clavicle, acromioclavicular and sternoclavicular joints). This creates a stable base for muscle activation, precise glenohumeral concavity/compression ball and socket kinematics throughout the arm motion, optimal force and energy transfer from the core to the hand, and efficient work through the system of the shoulder, arm, and hand. However, dysfunction of the scapula can negatively affect scapular stability, glenohumeral joint stability, and the ability to transfer energy. Scapular dysfunction occurs as the result of anatomic injury, suboptimal physiology, and/or altered biomechanics. This chapter provides current concepts of clinical understanding of scapular function and dysfunction in athletes and discusses preferred methods of evaluation and management of the dysfunction.


Kinetic chain Scapula Scapular dyskinesis Overhead athletics Shoulder injury 


  1. 1.
    Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg. 2012;20(6):364–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg. 2009;91A(2):378–89.CrossRefGoogle Scholar
  3. 3.
    McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elb Surg. 2001;10:269–77.CrossRefGoogle Scholar
  4. 4.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Kibler WB, Ludewig PM, McClure PW, Uhl TL, Sciascia AD. Scapula summit 2009. J Orthop Sports Phys Ther. 2009;39(11):A1–A13.PubMedCrossRefGoogle Scholar
  7. 7.
    Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Scapular position and orientation in throwing athletes. Am J Sports Med. 2005;33(2):263–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240–8.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Sciascia AD, Thigpen CA, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc Rev. 2012;20(1):16–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med. 2013;32(4):637–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete’s shoulder. Clin Sports Med. 2008;27(4):527–52.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Oyama S, Myers JB, Wassinger CA, Ricci RD, Lephart SM. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008;43(6):565–70.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Seitz AL, Reinold M, Schneider RA, Gill TJ, Thigpen CA. No effect of scapular position on 3-dimensional scapular in the throwing shoulder of healthy professional pitchers. J Sport Rehabil. 2012;21(2):186–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Borich MR, Bright JM, Lorello DJ, Cieminski CJ, Buisman T, Ludewig PM. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. J Orthop Sports Phys Ther. 2006;36:926–34.PubMedCrossRefGoogle Scholar
  17. 17.
    Cools AM, Witvrouw EE, DeClercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment pattern: trapezius muscle latency with and without impingement symptoms. Am J Sports Med. 2003;31:542–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Cools A, Johansson FR, Cambier DC, Velde AV, Palmans T, Witvrouw EE. Descriptive profile of scapulothoracic position, strength, and flexibility variables in adolescent elite tennis players. Br J Sports Med. 2010;44:678–84.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90–104.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    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
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Kibler WB, Sciascia AD. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300–5.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    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
  28. 28.
    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
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Kibler WB, Dome DC. Internal impingement: concurrent superior labral and rotator cuff injuries. Sports Med Arthrosc Rev. 2012;20(1):30–3.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    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. 2012;94(17):1576–83.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Dines JS, Frank JB, Akerman M, Yocum LA. Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency. Am J Sports Med. 2009;37(3):566–70.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    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
  35. 35.
    Mihata T, McGarry MH, Kinoshita M, Lee TQ. Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement. Am J Sports Med. 2010;38(2):369–82.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Weiser WM, Lee TQ, McQuade KJ. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med. 1999;27:801–5.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Falla D, Farina D, Graven-Nielsen T. Experimental muscle pain results in reorganization of coordination among trapezius muscle subdivisions during repetitive shoulder flexion. Exp Brain Res. 2007;178:385–93.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Cools AM, Witvrouw EE, Mahieu NN, Danneels LA. Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms. J Athl Train. 2005;40(2):104–10.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Tsai NT, McClure P, Karduna AR. Effects of muscle fatigue on 3-dimensional scapular kinematics. Arch Phys Med Rehabil. 2003;84:1000–5.PubMedCrossRefGoogle Scholar
  41. 41.
    McQuade KJ, Dawson JD, Smidt GL. Scapulothoracic muscle fatique associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation. J Orthop Sports Phys Ther. 1998;28(2):74–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Cools AM, Witvrouw EE, DeClercq GA, Vanderstraeten GG, Cambier DC. Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. Br J Sports Med. 2004;38:64–8.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes, the “dead arm” revisited. Clin Sports Med. 2000;19(1):125–58.PubMedCrossRefGoogle Scholar
  44. 44.
    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.PubMedCrossRefGoogle Scholar
  45. 45.
    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.PubMedCrossRefGoogle Scholar
  46. 46.
    Kibler WB. The role of the scapula in athletic function. Am J Sports Med. 1998;26:325–37.PubMedCrossRefGoogle Scholar
  47. 47.
    Kebaetse M, McClure PW, Pratt N. Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Arch Phys Med Rehabil. 1999;80:945–50.PubMedCrossRefGoogle Scholar
  48. 48.
    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.PubMedCrossRefGoogle Scholar
  49. 49.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    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. 2006;88:35–40.PubMedGoogle Scholar
  51. 51.
    Kibler WB, Sciascia A, Uhl T. Medial scapular muscle detachment: clinical presentation and surgical treatment. J Shoulder Elb Surg. 2014;23(1):58–67.CrossRefGoogle Scholar
  52. 52.
    Kibler WB, McMullen J, Uhl TL. Shoulder rehabilitation strategies, guidelines, and practice. Oper Tech Sports Med. 2000;8(4):258–67.CrossRefGoogle Scholar
  53. 53.
    Sciascia A, Cromwell R. Kinetic chain rehabilitation: A theoretical framework. Rehabil Res Pract. 2012;2012:1–9.Google Scholar
  54. 54.
    Kibler WB. Scapular surgery I-IV. In: Reider B, Terry MA, Provencher MT, editors. Sports medicine surgery. Philadelphia: Elsevier Saunders; 2010. p. 237–67.Google Scholar
  55. 55.
    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.CrossRefGoogle Scholar
  56. 56.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the scapular assistance test. J Orthop Sports Phys Ther. 2006;36(9):653–60.PubMedCrossRefGoogle Scholar
  59. 59.
    Kibler WB, Press J, Sciascia AD. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98.PubMedCrossRefGoogle Scholar
  60. 60.
    Hardcastle P, Nade S. The significance of the trendelenburg test. J Bone Joint Surg. 1985;67(5):741–6.CrossRefGoogle Scholar
  61. 61.
    Radwan A, Francis J, Green A, Kahl E, Maciurzynski D, Quartulli A, et al. Is there a relation between shoulder dysfunction and core instability? Int J Sports Phys Ther. 2014;9(1):8–13.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Reeser JC, Joy EA, Porucznik CA, Berg RL, Colliver EB, Willick SE. Risk factors for volleyball-related shoulder pain and dysfunction. Phys Med Rehabil. 2010;2(1):27–35.Google Scholar
  63. 63.
    Kibler WB, Sciascia AD, Moore SD. An acute throwing episode decreases shoulder internal rotation. Clin Orthop Relat Res. 2012;470:1545–51.PubMedCrossRefGoogle Scholar
  64. 64.
    Wilk KE, Reinhold MM, Macrina LC, Porterfield R, Devine KM, Suarez K, et al. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health. 2009;1(2):131–6.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    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.PubMedCrossRefGoogle Scholar
  66. 66.
    McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train. 2000;35(3):329–37.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • W. Ben Kibler
    • 1
  • Aaron Sciascia
    • 2
  1. 1.Shoulder Center of KentuckyLexingtonUSA
  2. 2.Lexington ClinicLexingtonUSA

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