Kinematics of Scapular Motion

  • William Ben KiblerEmail author
  • Aaron Sciascia


The scapula plays a key role in virtually all aspects of normal shoulder function. Scapular motion is complex as it occurs both physiologically and accessory to humeral motion via multiple translations and rotations. Alterations in scapular position and motion can be found in association with most shoulder injuries and are most commonly known as scapular dyskinesis. Scapular dyskinesis is a nonspecific response to a painful condition in the shoulder rather than a specific response to certain glenohumeral pathology which suggests the condition should be viewed as a physical impairment rather than a diagnostic entity. An understanding of normal scapular motion can assist in identifying abnormalities of scapular motion. Additionally, the scapular evaluation should aid clinicians in applying treatment approaches which are directed at either restoring scapular function or reducing the symptoms created by the dysfunction.


Sick Scapula Kinematics Scapula Throwing 

Supplementary material

Video 28.1

Video Physiological Scapula Winging. Clinical examination of a 16-year-old girl, with physiological winging. Note the poor control of the scapula and entire shoulder girdle. She rapidly fatigues, struggling to even lift the arm. Fortunately with directed physiotherapy she can regain a functional shoulder (Video courtesy of Dr Simon Bell, Melbourne, Australia) (MOV 6229 kb)


  1. 1.
    Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J Phys Med Rehabil. 1988;67:238–45.PubMedGoogle Scholar
  2. 2.
    Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder. Clin Orthop Relat Res. 1996;330:3–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Bagg SD, Forrest WJ. Electromyographic study of the scapular rotators during arm abduction in the scapular plane. Am J Phys Med. 1986;65(3):111–24.PubMedGoogle Scholar
  4. 4.
    Speer KP, Garrett WE. Muscular control of motion and stability about the pectoral girdle. In: Matsen Iii FA, Fu F, Hawkins RJ, editors. The shoulder: a balance of mobility and stability. Rosemont: American Academy of Orthopaedic Surgeons; 1994. p. 159–73.Google Scholar
  5. 5.
    Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennett B. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999;29(10):574–86.PubMedCrossRefGoogle Scholar
  6. 6.
    McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg. 2001;10:269–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Ludewig PM, Cook TM, Nawoczenski DA. Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. 1996;24(2):57–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Ludewig PM, Behrens SA, Meyer SM, Spoden SM, Wilson LA. Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. J Orthop Sports Phys Ther. 2004;34(3):140–9.PubMedCrossRefGoogle Scholar
  9. 9.
    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 Am. 2009;91A(2):378–89.CrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Kibler WB, Chandler TJ, Shapiro R, Conuel M. Muscle activation in coupled scapulohumeral motions in the high performance tennis serve. Br J Sports Med. 2007;41:745–9.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Nichols TR. A biomechanical perspective on spinal mechanics of coordinated muscular action. Acta Anat. 1994;15:1–13.CrossRefGoogle Scholar
  13. 13.
    Hirashima M, Kadota H, Sakurai S, Kudo K, Ohtsuki T. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. J Sports Sci. 2002;20:301–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Zattara M, Bouisset S. Posturo-kinetic organisation during the early phase of voluntary upper limb movement. 1 Normal subjects. J Neurol Neurosurg Psychiatry. 1988;51:956–65.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Young JL, Herring SA, Press JM, Casazza BA. The influence of the spine on the shoulder in the throwing athlete. J Back Musculoskelet Rehabil. 1996;7:5–17.PubMedCrossRefGoogle Scholar
  16. 16.
    Kibler WB, Press J, Sciascia AD. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98.PubMedCrossRefGoogle Scholar
  17. 17.
    Kibler WB, McMullen J, Uhl TL. Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am. 2000;8(4):258–67.Google Scholar
  18. 18.
    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
  19. 19.
    Nieminen H, Niemi J, Takala EP, Viikari-Juntura E. Load-sharing patterns in the shoulder during isometric flexion tasks. J Biomech. 1995;28(5):555–66.PubMedCrossRefGoogle Scholar
  20. 20.
    Lippitt S, Vanderhooft JE, Harris SL, Sidles JA, Harryman Ii DT, Matsen Iii FA. Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elbow Surg. 1993;2(1):27–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Veeger HEJ, van der Helm FCT. Shoulder function: the perfect compromise between mobility and stability. J Biomech. 2007;40:2119–29.PubMedCrossRefGoogle Scholar
  22. 22.
    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
  23. 23.
    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
  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.
    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
  26. 26.
    Kuhn J, Plancher K, Hawkins R. Scapular winging. J Am Acad Orthop Surg. 1995;3:319–25.PubMedGoogle Scholar
  27. 27.
    Kuhne M, Boniquit N, Ghodadra N, Romeo AA, Provencher MT. The snapping scapula: diagnosis and treatment. Arthroscopy. 2009;25(11):1298–311.PubMedCrossRefGoogle Scholar
  28. 28.
    Herzmark MH. Traumatic paralysis of the serratus anterior relieved by transplantation of the rhomboidei. J Bone Joint Surg Am. 1951;33:235–8.PubMedGoogle Scholar
  29. 29.
    Steinman S, Wood M. Pectoralis major transfer for serratus anterior paralysis. J Shoulder Elbow Surg. 2003;12:555–60.CrossRefGoogle Scholar
  30. 30.
    Wright TA. Accessory spinal nerve injury. Clin Orthop Relat Res. 1975;108:15–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Bigliani LU, Perez-Sanz IR, Wolfe IN. Treatment of trapezius paralysis. J Bone Joint Surg Am. 1985;67:871–7.PubMedGoogle 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.PubMedCrossRefGoogle Scholar
  33. 33.
    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
  34. 34.
    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
  35. 35.
    Kibler WB, Ludewig PM, McClure PW, Uhl TL, Sciascia AD. Scapula summit 2009. J Orthop Sports Phys Ther. 2009;39(11):A1–13.PubMedCrossRefGoogle Scholar
  36. 36.
    Warner JJP, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med. 1990;18(4):366–75.PubMedCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Endo K, Yukata K, Yasui N. Influence of age on scapulo-thoracic orientation. Clin Biomech (Bristol, Avon). 2004;19:1009–13.CrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    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
  42. 42.
    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
  43. 43.
    Harryman II DT, Sidles JA, Clark JM, McQuade KJ, Gibb TD, Matsen Iii FA. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am. 1990;72(9):1334–43.PubMedGoogle Scholar
  44. 44.
    Lin JJ, Hanten WP, Olson SL, Roddey TS, Soto-Quijano DA, Lim HK, et al. Functional activities characteristics of shoulder complex movements: exploration with a 3-D electromagnetic measurement system. J Rehabil Res Dev. 2005;42(2):199–210.PubMedCrossRefGoogle Scholar
  45. 45.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    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.PubMedGoogle Scholar
  47. 47.
    Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, et al. Rehabilitation of scapular muscle balance. Am J Sports Med. 2007;35(10):1744–51.PubMedCrossRefGoogle Scholar
  48. 48.
    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
  49. 49.
    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
  50. 50.
    McClure P, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther. 2006;86:1075–90.PubMedGoogle Scholar
  51. 51.
    Graichen H, Stammberger T, Bonel H, Wiedemann E, Englmeier KH, Reiser M, et al. Three-dimensional analysis of shoulder girdle and supraspinatus motion patterns in patients with impingement syndrome. J Orthop Res. 2001;19(6):1192–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Mell AG, LaScalza S, Guffey P, Carpenter JE, Hughes RE. Effect of rotator cuff pathology on shoulder rhythm. J Shoulder Elbow Surg. 2005;14:S58–64.CrossRefGoogle Scholar
  53. 53.
    Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90–104.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Karduna AR, Kerner PJ, Lazarus MD. Contact forces in the subacromial space: effects of scapular orientation. J Shoulder Elbow Surg. 2005;14:393–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Kibler WB. What is a clinically important superior labrum anterior to posterior tear? In: Pagano MW, Hart RA, editors. Instructional course lectures, vol. 62. Rosemont: American Academy of Orthopaedic Surgeons; 2013. p. 483–9.Google Scholar
  56. 56.
    Kibler WB, Dome DC. Internal impingement: concurrent superior labral and rotator cuff injuries. Sports Med Arthrosc. 2012;20(1):30–3.PubMedCrossRefGoogle Scholar
  57. 57.
    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.PubMedCrossRefGoogle Scholar
  58. 58.
    Ledger M, Leeks N, Ackland T, Wang A. Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elbow Surg. 2005;14(4):349–54.PubMedCrossRefGoogle Scholar
  59. 59.
    Matsumura N, Ikegami H, Nakamichi N, Nakamura T, Nagura T, Imanishi N, et al. Effect of shortening deformity of the clavicle on scapular kinematics: a cadaveric study. Am J Sports Med. 2010;38(5):1000–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1–10.Google Scholar
  61. 61.
    Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg. 2004;13:24–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Hardcastle P, Nade S. The significance of the Trendelenburg test. J Bone Joint Surg Br. 1985;67(5):741–6.PubMedGoogle Scholar
  63. 63.
    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.PubMedCrossRefGoogle Scholar
  64. 64.
    Kibler WB, Sciascia A, Uhl T. Medial scapular muscle detachment: clinical presentation and surgical treatment. J Shoulder Elbow Surg. 2014;23(1):58–67.PubMedCrossRefGoogle Scholar
  65. 65.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    Kluemper M, Uhl TL, Hazelrigg H. Effects of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers. J Sport Rehabil. 2006;15(1):58–70.Google Scholar
  68. 68.
    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.PubMedCrossRefGoogle Scholar
  69. 69.
    Kibler WB. The role of the scapula in athletic function. Am J Sports Med. 1998;26:325–37.PubMedGoogle Scholar
  70. 70.
    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
  71. 71.
    Seitz AL, McClure P, Lynch SS, Ketchum JM, Michener LA. Effects of scapular dyskinesis and scapular assistance test on subacromial space during static arm elevation. J Shoulder Elbow Surg. 2012;21(5):631–40.PubMedCrossRefGoogle Scholar

Copyright information

© ISAKOS 2015

Authors and Affiliations

  1. 1.Shoulder Center of KentuckyLexingtonUSA

Personalised recommendations