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Scapular Examination

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Disorders of the Scapula and Their Role in Shoulder Injury

Abstract

The scapular examination is an important component when examining the patient with shoulder pain. Several factors must be considered to determine if scapula dysfunction is contributing to the patient’s symptoms. The focus on this chapter is to guide the clinician in how to logically examine the scapula using his or her eyes and hands primarily. There are basically three components of the scapular examination: (1) visual observation, (2) manual correction of scapular position, and (3) examination of surrounding tissue inspecting flexibility and muscular performance. There is a fundamental understanding of normal scapular motion and muscular function that is necessary to identify when dysfunction is present. Other chapters have detailed kinematic and muscular function that is crucial to understand in order to examine the scapula. This chapter will provide the clinician with current best evidence and logical progression to evaluate the role of scapular dysfunction in a patient with shoulder pain in order to direct appropriate intervention based on tissue level of irritability and associated impairments.

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References

  1. Endo K, Ikata T, Katoh S, Takeda Y. Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome. J Orthop Sci. 2001;6(1):3–10. PubMed PMID: 11289583. Epub 2001/04/06. eng.

    Google Scholar 

  2. 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. PubMed PMID: 11781023.

    Google Scholar 

  3. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. PhysTher. 2000;80(3):276–91. PubMed PMID: 710.

    Google Scholar 

  4. 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. PubMed PMID: 285.

    Google Scholar 

  5. McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther. 2004;84(9):832–48. PubMed PMID: 15330696.

    Google Scholar 

  6. 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. PubMed PMID: 45.

    Google Scholar 

  7. 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. PubMed PMID: 16881465. Epub 2006/08/03. eng.

    Google Scholar 

  8. McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther. 2006;86(8):1075–90. PubMed PMID: 16879042.

    Google Scholar 

  9. Myers JB, Oyama S, Hibberd EE. Scapular dysfunction in high school baseball players sustaining throwing-related upper extremity injury: a prospective study. J Shoulder Elb Surg. 2013;22(9):1154–9. PubMed PMID: 23419606.

    Google Scholar 

  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;44:165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med. 2014;48(17):1327–33. PubMed PMID: 24948083.

    Google Scholar 

  12. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20. PubMed PMID: 1643.

    Google Scholar 

  13. 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. PubMed PMID: 1567.

    Google Scholar 

  14. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11:142–51. PubMed PMID: 1313.

    Google Scholar 

  15. Kibler WB, Uhl TL, Maddux JQ, McMullen J, Brooks PV, Zeller B. Qualitative clinical evaluation of scapular dysfunction. A reliability study. J Shoulder Elb Surg. 2002;11(6):550–6. PubMed PMID: 1314.

    Google Scholar 

  16. 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. PubMed PMID: 17017270.

    Google Scholar 

  17. Tate AR, McClure PW, 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. PubMed PMID: 18357656.

    Google Scholar 

  18. Kibler WB, Ludewig PM, McClure PW, Uhl TL, Sciascia A. Scapular summit 2009. J Orthop Sports Phys Ther. 2009;39(11):A1–13. PubMed PMID: 19881011. Epub 2009/11/03. eng.

    Google Scholar 

  19. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300–5.

    Article  PubMed  Google Scholar 

  20. Tate AR, McClure PW. Examination and management of scapular dysfunction. In: Skirven TM, editor. Rehabilitation of the hand and upper extremity. Philadelphia: Mosby/Elsevier; 2010.

    Google Scholar 

  21. Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, et al. Association between kyphosis and subacromial impingement syndrome: LOHAS study. J Shoulder Elb Surg. 2014;23(12):e300–e7. PubMed PMID: 25107600.

    Google Scholar 

  22. Yang S, Feuchtbaum E, Werner BC, Cho W, Reddi V, Arlet V. Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically? Eur Spine J 2012;21(10):1978–83. PubMed PMID: 22842954. PMCID: PMC3463704.

    Google Scholar 

  23. Kebaetse M, McClure P, Pratt N. Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinetics. Arch Phys Med Rehabil. 1999;80:945–50. PubMed PMID: 343.

    Google Scholar 

  24. Lewis JS, Green A, Wright C. Subacromial impingement syndrome: the role of posture and muscle imbalance. J Shoulder Elb Surg. 2005;14(4):385–92. PubMed PMID: 16015238. Epub 2005/07/15. eng.

    Google Scholar 

  25. Lewis JS, Valentine RE. Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain. BMC Musculoskelet Disord. 2010;11:39. PubMed PMID: 20193055. PMCID: PMC2845095.

    Google Scholar 

  26. Lynch SS, Thigpen CA, Mihalik JP, Prentice WE, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44(5):376–81. PubMed PMID: 20371564.

    Google Scholar 

  27. Seitz AL, McClure PW, Finucane S, Boardman ND, 3rd, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech (Bristol, Avon). 2011;26(1):1–12. PubMed PMID: 20846766. Epub 2010/09/18. eng.

    Google Scholar 

  28. Solem-Bertoft E, Thuomas KA, Westerberg CE. The influence of scapular retraction and protraction on the width of the subacromial space. An MRI study. Clin Orthop Relat Res. 1993 (296):99–103. PubMed PMID: 1430.

    Google Scholar 

  29. 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. PubMed PMID: 1565.

    Google Scholar 

  30. Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26(2):325–37. PubMed PMID: 30.

    Google Scholar 

  31. Odom CJ, Taylor AB, Hurd CE, Denegar CR. Measurement of scapular asymmetry and assessment of shoulder dysfunction using the lateral scapular slide test: a reliability and validity study. Phys Ther. 2001;81(2):799–809. PubMed PMID: 1396.

    Google Scholar 

  32. Koslow PA, Prosser LA, Strony GA, Suchecki SL, Mattingly GE. Specificity of the lateral scapular slide test in asymptomatic competitive athletes. J Orthop Sports Phys Ther. 2003;33(6):331–6.

    Article  PubMed  Google Scholar 

  33. Nijs J, Roussel N, Vermeulen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests. Arch Phys Med Rehabil. 2005;86(7):1349–55. PubMed PMID: 16003663. Epub 2005/07/09. eng.

    Google Scholar 

  34. 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:–4.

    Google Scholar 

  35. Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240–8. PubMed PMID: 19896045. Epub 2009/11/10. eng.

    Google Scholar 

  36. Kibler WB, Sciascia A, Dome D. 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. PubMed PMID: 16735587.

    Google Scholar 

  37. Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes, the “dead arm” revisited. Clin Sports Med. 2000;19(1):125–58. PubMed PMID: 646.

    Google Scholar 

  38. Seitz AL, McClure PW, Finucane S, Ketchum JM, Walsworth MK, Boardman ND, et al. The scapular assistance test results in changes in scapular position and subacromial space but not rotator cuff strength in subacromial impingement. J Orthop Sports Phys Ther. 2012;42(5):400–12. PubMed PMID: 22333409. Epub 2012/02/16. eng.

    Google Scholar 

  39. Ludewig PM, Hoff MS, Osowski EE, Meschke SA, Rundquist PJ. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004;32(2):484–93. PubMed PMID: 1525.

    Google Scholar 

  40. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20(4):701–9. PubMed PMID: 20097090.

    Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. Kendall FP, EK MC, Provance PG, Butler JP. Muscles testing and function. Baltimore: Williams and Wilkins; 1993.

    Google Scholar 

  43. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res. 1996;(330):3–12. PubMed PMID: 8804269. Epub 1996/09/01. eng.

    Google Scholar 

  44. Watson CJ, Schenkman M. Physical therapy management of isolated serratus anterior muscle paralysis. Phys Ther. 1995;75(3):194–202. PubMed PMID: 7870751. Epub 1995/03/01. eng.

    Google Scholar 

  45. Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007;35(10):1744–51. PubMed PMID: 17606671. Epub 2007/07/04. eng.

    Google Scholar 

  46. Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med. 2003;31(4):542–9.

    PubMed  Google Scholar 

  47. Johnson G, Bogduk N, Nowitzke A, House D. Anatomy and actions of the trapezius muscle. Clin Biomech. 1994;9:44–50.

    Article  CAS  Google Scholar 

  48. Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther. 2005;85(11):1128–38. PubMed PMID: 1306.

    Google Scholar 

  49. Smith J, Padgett DJ, Kaufman KR, Harrington SP, An KN, Irby SE. Rhomboid muscle electromyography activity during 3 different manual muscle tests. Arch Phys Med Rehabil. 2004;85:987–92. PubMed PMID: 1640.

    Google Scholar 

  50. Sahrmann SA. Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby; 2002.

    Google Scholar 

  51. Lewis JS, Valentine RE. The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musculoskelet Disord. 2007;8:64.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Borstad JD. Measurement of pectoralis minor muscle length: validation and clinical application. J Orthop Sports Phys Ther. 2008;38(4):169–74. PubMed PMID: 18434665. Epub 2008/04/25. eng.

    Google Scholar 

  53. Rosa DP, Borstad JD, Pires ED, Camargo PR. Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement. Braz J Phys Ther. 2016;20(2):176–83. PubMed PMID: 26982455.

    Google Scholar 

  54. Peterson DE, Blankenship KR, Robb JB, Walker MJ, Bryan JM, Stetts DM, et al. Investigation of the validity and reliability of four objective techniques for measuring forward shoulder posture. J Orthop Sports Phys Ther. 1997;25(1):34–42. PubMed PMID: 1402.

    Google Scholar 

  55. Kluemper M, Uhl TL, Hazelrigg H. Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers. J Sport Rehabil. 2006;15(1):58–70. PubMed PMID: 1641.

    Google Scholar 

  56. Laudner KG, Moline MT, Meister K. The relationship between forward scapular posture and posterior shoulder tightness among baseball players. Am J Sports Med. 2010;38(10):2106–12. PubMed PMID: 20595550. Epub 2010/07/03. Eng.

    Google Scholar 

  57. Awan R, Smith J, Boon AJ. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil. 2002;83:1229–34. PubMed PMID: 1599.

    Google Scholar 

  58. Ellenbecker TS, Roetert EP, Piorkowski PA, Schulz DA. Glenohumeral joint internal and external rotation range of motion in elite junior tennis players. J Orthop Sports Phys Ther. 1996;24(6):336–41. PubMed PMID: 8938599.

    Google Scholar 

  59. Edwards TB, Bostick RD, Greene CC, Baratta RV, Drez D. Interobserver and intraobserver reliability of the measurement of shoulder internal rotation by vertebral level. J Shoulder Elb Surg. 2002;11(1):40–2. PubMed PMID: 11845147.

    Google Scholar 

  60. Hayes K, Walton JR, Szomor ZR, Murrell GA. Reliability of five methods for assessing shoulder range of motion. Aust J Physiother. 2001;47(4):289–94. PubMed PMID: 11722295. Epub 2001/11/28. eng.

    Google Scholar 

  61. Gerber C, Werner CM, Macy JC, Jacob HA, Nyffeler RW. Effect of selective capsulorrhaphy on the passive range of motion of the glenohumeral joint. J Bone Joint Surg Am. 2003;85-A(1):48–55. PubMed PMID: 12533571.

    Google Scholar 

  62. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37(3):108–14. PubMed PMID: 17416125.

    Google Scholar 

  63. Laudner KG, Stanek JM, Meister K. Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction. J Athl Train. 2006;41

    Google Scholar 

  64. McClure PW, Michener LA. Staged approach for rehabilitation classification: shoulder disorders (STAR-Shoulder). Phys Ther. 2015;95(5):791–800. PubMed PMID: 25504491.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Physical Therapy, Arcadia University, 450 South Easton Road, Glenside, PA, 19038, USA

    Phil McClure PT, PhD, FAPTA

  2. Athletic Training Education Program, Eastern Kentucky University, 228 Moberly Building, 521 Lancaster Avenue, Richmond, KY, 40475, USA

    Aaron D. Sciascia PhD, ATC, PES (Assistant Professor)

  3. Division of Athletic Training, Department of Rehabilitation Sciences, College of Health Science, University of Kentucky, 210c C.T. Wethington Building, 900 South Limestrone, Lexington, KY, 40536-0200, USA

    Tim L. Uhl PhD, ATC, PT, FNATA

Authors
  1. Phil McClure PT, PhD, FAPTA
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  2. Aaron D. Sciascia PhD, ATC, PES
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  3. Tim L. Uhl PhD, ATC, PT, FNATA
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Corresponding author

Correspondence to Phil McClure PT, PhD, FAPTA .

Editor information

Editors and Affiliations

  1. Lexington Clinic Orthopedics and Sports Medicine Center, Lexington, Kentucky, USA

    W. Ben Kibler

  2. Eastern Kentucky University, Richmond, Kentucky, USA

    Aaron D. Sciascia

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McClure, P., Sciascia, A.D., Uhl, T.L. (2017). Scapular Examination. In: Kibler, W., Sciascia, A. (eds) Disorders of the Scapula and Their Role in Shoulder Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-53584-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-53584-5_4

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