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Scapular Dyskinesis

75 citationsUpdated Oct 2026
Illustration: shoulder

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Scapular dyskinesis is a nonspecific response to shoulder dysfunction that is likely a major contributor to pain, particularly in cases of recalcitrant symptoms [1, 3]. As a relatively new concept in shoulder assessment, it remains poorly understood and presents challenges for both diagnosis and management [3, 8]. While it may represent normal movement variability, it can also increase dysfunction in injured shoulders [9, 14]. Consequently, scapular dyskinesis should be suspected in patients with shoulder injury and identified through specific physical examination, including visual inspection and objective posture measurements [1, 2]. It is recommended to assess and treat scapular dyskinesis in patients with shoulder injury [14]. However, the clinical value of the scapular dyskinesis test is questioned in patients with subacromial impingement syndrome, as functional impairment and outcomes did not differ between patients with or without its presence [15].

Treatment strategies for shoulder injury can be more effectively implemented by evaluating the dyskinesis [6]. Rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive shoulder rehabilitation programme [6]. Physical therapy is suggested as the first treatment for degenerative cuff tears, with scapular dyskinesis addressed if present [5]. However, there is a lack of evidence for beneficial effects of exercise in improving scapular position and motion in individuals with scapular dyskinesis [17]. The modified scapular assistance test should not be used solely for the assessment of scapular dyskinesis in clinical practice, nor should it be influenced by the scapular dyskinesis test result [28].

Postsurgical protocols must consider scapular dyskinesia to improve outcomes [5]. Surgical treatment may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes following displaced fractures of the middle clavicle [11]. Scapular dyskinesis affects a significant number of patients following treatment of their proximal humerus fractures [12] and was found in 5 of 20 patients who underwent a Latarjet procedure [13]. Persistent scapular dyskinesis was observed after arthroscopic rotator cuff repair [24], and six months of rehabilitation treatment in the postoperative period is not enough to fully eliminate scapular dyskinesis after subacromial Lidocaine infiltration and rotator cuff reconstruction [25]. More than half of the scapular dyskinesis cases, especially type 1, improved postoperatively after rotator cuff repair and subacromial decompression [31]. Recovery of scapular dyskinesis correlated with better function and successful rotator cuff healing after rotator cuff repair and subacromial decompression [31].

Anatomy & Pathophysiology

Scapular Anatomy and Biomechanics

The scapula is a triangular bone with a superior base and inferior apex, bounded by superior, medial, and lateral borders and corresponding angles [66]. It is attached to the axial skeleton via the acromioclavicular and sternoclavicular joints [66]. The scapula is separated from the chest wall by thin gliding fibro-fatty tissue, allowing smooth excursion [66]. It is suspended by muscles alone and has shifted caudally from the cervical position seen in lower animals [74]. The scapula spans the second through seventh ribs and serves as an attachment site for 17 muscles [78]. It is anteverted approximately 30 degrees relative to the body and positioned approximately 45 degrees to the midline due to a decreased anteroposterior dimension of the thoracic cage [74, 78]. The glenoid fossa is directed laterally as a result of the scapula assuming a more dorsal position in the thoracic cage [74].

The glenoid is a convex structure of shallow depth shaped like an inverted pear [64]. It is connected to the flat body of the scapula by the scapular neck [66]. The glenoid is retroverted approximately 5 degrees relative to the scapular body [78]. The subchondral bone of the glenoid is relatively flat, and the articular concavity is augmented by cartilage and a circumferential labrum [67]. The scapula has only one true diarthrodial articulation, the acromioclavicular joint [67]. The acromion, coracoacromial ligament, and coracoid process form the coracoacromial arch, a rigid bony-ligamentous structure that imparts stability to the shoulder girdle [64]. The rotator cuff, subacromial bursa, and subdeltoid bursa pass underneath this arch [64].

The scapular spine is an osseous ridge that separates the supraspinatus and infraspinatus fossae [67]. It ends in a flattened bony process, the acromion, which curves forwards [66]. The acromion has three ossification centers: the metacromion, mesoacromion, and preacromion [67]. Failure of fusion of these centers results in os acromiale [67]. The coracoid process curves forwards from the superior surface of the scapular neck [66]. The coracobrachialis muscle and the short head of the biceps tendon originate from the coracoid process [67]. The pectoralis minor muscle inserts onto the medial coracoid process [67]. The superior transverse scapular ligament arises from the medial base of the coracoid overlying the suprascapular notch [67]. The suprascapular artery runs superior to this ligament, while the nerve runs deep to it [67]. Entrapment of the suprascapular nerve at the superior transverse scapular ligament causes denervation of both the supraspinatus and the infraspinatus [67]. The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [67]. Entrapment, traction, or compression of the nerve at this notch causes denervation of the infraspinatus [67].

The distribution of bony mass in the scapula is highly uneven, with areas of thick bone contrasting with areas that are almost translucent [66]. The highest concentration of bony mass is located in the glenoid, the scapular neck, and the lateral border of the scapular body [66]. Two bony pillars transmit compressive forces from the glenoid fossa: the lateral pillar and the spinal pillar [66]. The lateral pillar connects the inferior border of the glenoid with the inferior angle [66]. The spinal pillar arises from the central part of the glenoid and continues medially to become part of the base of the scapular spine [66]. These two pillars, connected by a markedly thinner medial border, form the basic load-bearing structure of the scapular body, constituting the biomechanical body [66]. The superior angle and adjacent supraspinous fossa form an appendage that serves as a surface for muscle insertion or origin but does not transmit compressive forces [66]. It is necessary to distinguish between the anatomical and biomechanical bodies of the scapula [66].

The weakest bone, only a few millimeters thick, is located primarily in the central part of the biomechanical body, specifically in the infraspinous fossa [66]. The weakest area of the circumference of the biomechanical body is the spinomedial angle, where the scapular spine connects with the medial border [66]. In most scapular body fractures, one of the main fracture lines passes through this region [66]. Another area of weak bone is in the central part of the scapular spine, where fracture lines are also frequently seen [66]. Knowledge of these thick and thin bone areas is important for the courses of fracture lines and the fixation of implants [66].

The scapula is mobile but provides efficient support to the humeral head, allowing compressive forces to be transmitted from the upper limb to the shoulder girdle without compromising stability or mobility of the glenohumeral joint [66]. The superior shoulder suspensory complex provides a stable connection between the scapula and the axial skeleton [67]. This complex is composed of the glenoid, coracoid process, coracoclavicular ligaments, distal clavicle, acromioclavicular joint, and acromion [67]. The extrinsic muscles primarily control scapular movement and include the rhomboids, levator scapulae, trapezius, and serratus anterior [77]. The scapula serves for attachment of a number of muscles originating from the axial skeleton that control its motion [66].

Normal shoulder motion is approximately two-thirds glenohumeral and one-third scapulothoracic [67]. The scapula must upwardly and externally rotate and posteriorly tilt adequately to prevent the humeral head from compressing and shearing against the under surface of the acromion [34]. The infraspinatus and teres minor muscles are more effective in their roles as depressors and external rotators of the humeral head due to a change in the vector of muscle pull from the axillary border of the scapula to the glenoid fossa [74]. The acromion is a massive structure overlying the humeral head in humans, reflecting the increasing role of the deltoid muscle in shoulder function [74]. The coracoid process can mechanically limit anterior translation of the humerus relative to the glenoid with the shoulder in 90 degrees of abduction [74].

Ossification of the scapular body begins at the eighth week of gestation [67]. The scapular index is extremely high in pronograde animals with a long, narrow scapula [74]. The scapula is broader in humans and other primates, with the most pronounced differences observed in the infraspinatus fossa [74]. Broadening of the infraspinatus fossa has resulted in a change in the vector of muscle pull from the axillary border of the scapula to the glenoid fossa [74]. The supraspinatus fossa and muscle have changed little in size or shape over time [74]. The acromion has enlarged over time, reflecting the increasing role of the deltoid muscle in shoulder function [74]. The coracoid process has undergone an increase in size over time [74].

Pathophysiology and Kinematics

Scapular dyskinesis is a nonspecific response to shoulder dysfunction that should be suspected in patients with shoulder injury [1]. It has been found in association with almost every pathologic injury in the shoulder and arm in the throwing athlete [23]. Dyskinesis can be identified in between 50 and 100% of throwers with injuries [23]. Scapular dyskinesis may be the primary instigator in the pathologic process that results in shoulder dysfunction [26]. It may be an associated condition that contributes to injury causation, exacerbates shoulder symptoms, or adversely influences management or outcomes [26]. Alternatively, it may be an adaptive condition that arises to compensate for other injury or discomfort [26]. In cases of nerve injury, fracture, AC separation, and muscle detachment, the injury creates the dyskinesis, which in turn affects shoulder function [26]. In cases of rotator cuff disease, labral injury, and multidirectional instability, the dyskinesis may be causative, creating pathomechanics that predispose the arm to such injuries [26]. Scapular dyskinesis may also be a response to injury, creating pathomechanics that increase the existing dysfunction [26].

Abnormal scapular position, such as increased protraction, reduced upward scapular rotation, and subsequent loss of appropriate acromial elevation, may lead to compression of the rotator cuff under the acromial arch [10]. Scapular dyskinesis may occur as a result of or in response to the shoulder injury as a form of compensation [10]. The causative role scapular dyskinesis plays in rotator cuff and biceps injuries is still unknown [10]. The cause and effect relationships between shoulder injuries and scapulothoracic kinematic abnormalities are not well-established [10]. Human cadaveric studies showed that alterations in scapular orientations and loading of the rotator cuff, deltoid, latissimus dorsi, and pectoralis major result in abnormal joint mechanics due to disruption of the normal balance of forces and joint orientations [10]. In vivo human studies identified altered scapular rhythm and position in patients with shoulder injury [10]. The in vivo cause and effect relationships that mechanical alterations and disruptions have on the rotator cuff and biceps properties over time cannot be evaluated using cadaveric studies or in vivo human studies [10]. Scapular dyskinesis is detrimental to shoulder tendon properties and joint mechanics in a rat model [10]. Scapular dyskinesis places the joint at risk for secondary injuries, including impingement and biceps pathology [10].

Kinematic analysis shows that asymmetries are common in symptomatic and asymptomatic populations [30]. Shoulders visually judged as having dyskinesis showed distinct alterations in 3-dimensional scapular motion [20]. Scapular dyskinesis identified during active motion did not result in different 3-D scapular orientation or acromiohumeral distance during active arm elevation in static positions [35]. The scapular assistance test altered scapular kinematics and increased acromiohumeral distance [35]. Scapular kinematics and proprioception should be evaluated after arthroscopic Bankart repair [41]. Scapular-predominant motion may reflect maladaptive kinematics, potentially resulting from residual stiffness, muscle dysfunction, implant malposition, or other factors that may disrupt restoration of native physiological shoulder mechanics [40].

Patients after anatomic total shoulder arthroplasty showed altered shoulder girdle kinematics and higher contribution of the shoulder girdle towards elevation [42]. Patients with symptomatic rotator cuff tears who reached at least 85 degrees compensated for the loss of glenohumeral motion by increased scapulothoracic contribution [43]. Structural damage interferes with motion mechanics in patients with symptomatic rotator cuff tears [43]. Scapular motion is abnormal in the presence of a rotator cuff tear [108]. The literature is inconsistent regarding a universally affected variable or consistent degree of scapular dysfunction in the presence of a rotator cuff tear [108]. Increasing severity of glenohumeral osteoarthritis leads to a reduced motion of the glenohumeral joint, while the magnitude of the scapulothoracic motion increases [103]. There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following total shoulder arthroplasty compared to asymptomatic shoulders [104]. Reverse shoulder arthroplasty shoulders have an increased contribution of the scapulothoracic joint during arm elevation compared with asymptomatic shoulders [111]. Scapulothoracic motion is more complex than previously reported, especially in patients with rotator cuff arthropathy [112]. Patients with rotator cuff arthropathy exhibit a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation [112]. Clavicle shortening of greater than 10% greatly affects scapular kinematics in vivo [94]. Although the supraspinatus and infraspinatus do not directly control the movement of the scapula, they appear to result in a compensatory change in scapular motion [100].

Scapular dyskinesis is not an isolated risk factor for shoulder injury in athletes [19]. The dichotomization of scapular control into "normal" or "dyskinesis" may be too simplistic to identify if scapular dyskinesis predisposes athletes to the development of shoulder injury [19]. "Obvious scapular dyskinesis," not "slight scapular dyskinesis," imposed a statistically significant increased risk for shoulder injury [19]. Only the subset of scapular dyskinesis involving excessive scapular elevation was associated with increased injury risk [19]. The scapular dyskinesis test does not replicate the sports-specific demands placed on the shoulder [19]. It remains possible that impairments identified when performing movement at greater velocity or load may predispose athletes to shoulder injury [19]. An athlete’s scapular positioning and motion can change during a season in response to sport-specific demands and increased load on the shoulder [19].

Classification

Scapular dyskinesis is a nonspecific response to shoulder dysfunction that can be identified and classified by specific physical examination [1]. The presence or absence of scapular dyskinesis is determined during clinical examination through visual inspection and objective posture measurements [2]. Kinematic analysis shows that asymmetries are common in both symptomatic and asymptomatic populations [30]. Scapular dyskinesis was observed in 28.7% of the shoulders in asymptomatic European professional basketball players [21]. In a study of 75 participants, 39% to 53% were categorized with altered position or motion of the scapula during arm movements [50]. In a study of 186 subjects, the numbers of subjects with scapular dyskinesis type I, II, III, and IV were 28, 41, 71, and 46, respectively [61]. Scapular dyskinesis can be identified in between 50 and 100% of throwers with injuries [23].

Inter-rater Reliability: Three classifications of scapular dyskinesis presented agreement values ranging from 80% to 95.9% [50]. All classifications of scapular dyskinesis presented almost perfect reliability (k > 0.81), except the 4-type and SDT classifications [50].

Clinician Bias: Clinicians who considered scapular dyskinesis more important were more likely to classify it as present (OR = 1.42) [18]. Clinicians seeing more shoulder patients weekly were less likely to classify scapular dyskinesis as present (OR = 0.77) [18].

Other Considerations: Chronic type III acromioclavicular dislocation causes scapular dyskinesis in 70.6% of patients [109]. Of patients with chronic type III acromioclavicular dislocation and scapular dyskinesis, 58.3% have SICK scapula syndrome develop [109]. In a modified Latarjet technique study, scapular dyskinesis occurred in 5 TL patients (25%) and none in the PMRL group [58]. In all cases of scapular dyskinesis following the modified Latarjet technique, a Type III dyskinesis was present [58]. Scapular kinematics and impairment features can be used to classify subjects with subacromial impingement syndrome in addition to self-report [56]. Measurement instruments to assess scapular dyskinesis are prone to misinterpretation and should therefore not be used as such [33].

Clinical Presentation

Scapular dyskinesis is a relatively new concept in the assessment of shoulder pathology and is likely a major contributor to shoulder pain, particularly in cases of recalcitrant shoulder pain and dysfunction [3]. It may act as the primary instigator in the pathologic process resulting in shoulder dysfunction, an associated condition that contributes to injury causation or exacerbates symptoms, or an adaptive condition that arises to compensate for other injury or discomfort [26]. The condition is associated with poorer clinical and functional outcomes and mediates the relationship between scapular endurance and functional status [22].

Clinical Assessment and Examination

The current recommendation for clinical assessment is the use of the "scapular dyskinesis tests," which consists of clinical observation of the medial and inferior scapular borders for winging or medial border prominence, lack of a smooth coordinated movement as exemplified by early scapular elevation or shrugging during ascending arm forward flexion, and rapid downward rotation during arm lowering from full flexion [46]. Failure of a properly positioned scapula results in medial border prominence, in static position, upward/downward motion, or altered dyssynchronous motion, and is considered the hallmark clinical identifier of dyskinesis [46]. The test for scapular dyskinesis showed satisfactory reliability for clinical use in a sample of overhead athletes known to be at increased risk for shoulder symptoms [45]. The Y-N classification is reliable in detecting scapular dyskinesis in asymptomatic individuals regardless of experience [97]. However, a clinical evaluation of altered shoulder kinematics is still complicated [32].

The mSAT should not be used solely for the assessment of scapular dyskinesis in clinical practice nor be influenced by the scapular dyskinesis test result [28]. Findings that functional impairment and outcomes did not differ between patients with or without the presence of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome [15].

The SRT was developed to help differentiate shoulder weakness attributable to scapular dyskinesia [52]. Improvement in demonstrated supraspinatus strength upon scapular stabilization versus the empty can test without such stabilization denotes a positive SRT and suggests scapular dyskinesis [52]. A negative SRT represents no improvement in supraspinatus strength and is found for patients with a full-thickness RCT [52]. The SRT has a sensitivity of 81.7% and a specificity of 80.8% for diagnosing full-thickness RCTs [52]. It has a positive likelihood ratio of 4.25 and a negative likelihood ratio of 0.23 [52]. The SRT has a positive predictive value of 83.5% and a negative predictive value of 78.7% [52], with an overall test accuracy of 81.3% [52].

Scapular winging often mimics more common shoulder abnormalities and can result in unnecessary or unsuccessful surgical procedures [29].

Prevalence and Associations

Scapular dyskinesis was found to have a greater reported prevalence (61%) in overhead athletes compared with nonoverhead athletes (33%) [44]. Out of 75 participants, 39% to 53% were categorized with altered position or motion of the scapula during arm movements [50]. Early diagnosis may be useful for asymptomatic athletes with scapular dyskinesis and to avoid its possible evolution to a symptomatic condition [27].

Scapular dyskinesis caused by tumors in the scapulothoracic joint may result in subacromial impingement syndrome [49]. Pain and impingement signs disappeared after tumor excision without specific intervention to treat the subacromial pathology in cases of scapular dyskinesia caused by tumors [49].

Investigations

Clinical Examination and Physical Testing

Scapular dyskinesis is a nonspecific response to shoulder dysfunction that should be suspected in patients with shoulder injury and can be identified and classified by specific physical examination [1]. Because scapular dyskinesis may increase dysfunction in injured shoulders, it is recommended to assess and treat scapular dyskinesis in patients with shoulder injury [14]. Demonstrated apparent supraspinatus weakness on clinical examination in symptomatic patients may be dependent on scapular position [98]. The Scapular Retraction Test (SRT) was developed to help differentiate shoulder weakness attributable to scapular dyskinesia [52]. A negative SRT result represents no improvement in supraspinatus strength and is found for patients with a full-thickness rotator cuff tear [52]. The SRT has a sensitivity of 81.7% and a specificity of 80.8% for diagnosing full-thickness rotator cuff tears, with an overall test accuracy of 81.3% [52]. The scapular assistance test (SAT) altered scapular kinematics and increased acromiohumeral distance [35]. The modified scapular assistance test (mSAT) should not be used solely for the assessment of scapular dyskinesis in clinical practice nor be influenced by the scapular dyskinesis test result [28].

Imaging and Ancillary Studies

The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [39]. A robust approach to imaging the shoulder needs to recognize that the shoulder is a three-dimensional structure that cannot be represented by a single planar view [84]. Critical relationships—such as the degree of centering of the humeral head—change with the position of the arm [84]. Shoulder pathology may be found in a large number of different bones and soft tissues [84]. Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [84]. Surgeons need to develop a judicious approach to imaging that yields the information necessary to treat the patient while avoiding the tendency to "over-image" [84]. Unless a specific research protocol is in place, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [39].

Plain radiography: Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [39]. Initially, all patients are usually asked to have AP and lateral plain radiographs of the shoulder related to their chief report [88]. At least two X-ray views should be obtained for shoulder imaging: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction to show the relationship of the humeral head to the glenoid [81]. The standard shoulder series should include orthogonal views of the shoulder, including a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [89]. The first key radiographic view is the anteroposterior (AP) in the plane of the scapula taken so that the x-ray beam passes through the glenohumeral joint [39]. The true AP view in the scapular plane visualizes the anterior greater tuberosity in profile and can reveal proximal humeral migration [89]. The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula, referred to as the “truth view” [39]. The standardized axillary truth view demonstrates glenohumeral relationships in the functional position of elevation [39]. The axillary view is necessary for evaluation of glenohumeral joint instability and enables determination of the humeral head position in the glenoid fossa [89]. The scapular Y view provides visualization of the coracoacromial arch and can reveal coracoacromial spurs, which have been closely associated with the presence of rotator cuff pathology [89]. The scapular Y view is a reliable alternative for evaluation of glenohumeral subluxation and dislocation and can show scapular body abnormalities (eg, osteochondroma, fracture) and acromial shape [89].

MRI: Magnetic resonance imaging (MRI) is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [88]. Traditional magnetic resonance imaging (MRI) is utilized for evaluation of soft tissues with high contrast and spatial resolution in the management of patients with anterior shoulder instability [86]. MRI is useful to identify osteonecrosis of the humeral head, or a bone tumour [81]. MRI can identify labral tears and rotator cuff tears, although the accuracy for these is enhanced by combining the scan with arthrography [81]. T1-weighted MRI can reveal Hill-Sachs lesions and is often used with magnetic resonance (MR) arthrograms to provide a more detailed picture of the joint surfaces [88]. T2-weighted MRI provides better visualization of full thickness rotator cuff tears [88]. MR accuracy in identifying labral and rotator cuff tears in the literature ranges from 70% to 100% [86]. MR arthrography (MRA) refers to MRI of a joint that has been injected with an intra-articular contrast agent such as diluted gadolinium or saline solution [86]. MRA has proven utility by increasing both sensitivity and specificity in detecting injuries to the capsulolabral–ligamentous complex as compared to traditional MRI [86]. In a meta-analysis of 4,667 shoulders, MRA had greater diagnostic test accuracy for glenoid labral lesions than MRI (MRA sensitivity 88% and specificity 93% vs. MRI sensitivity 76% and specificity 87%) [86]. MR arthrography is considered the benchmark for evaluation for labral tears and rarely is indicated for evaluation of rotator cuff pathology [88]. Abduction and external rotation (ABER) of the arm is an alternative position utilized to increase the sensitivity and specificity for detecting anteroinferior labroligamentous injury [86]. The sensitivity of MRA with the ABER position for detecting anteroinferior labral lesions was significantly higher than that of the MRA in neutral position [86]. MRAs can demonstrate a patulous capsule on the coronal, sagittal, and axial imaging in patients with multidirectional instability [86]. The diagnosis of multidirectional instability is a clinical one, and the need for expensive and/or invasive imaging should be weighed against the information that will be gained from these studies [86]. When MRI or MR arthrography is contraindicated, CT arthrography is indicated [88].

CT: Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [81]. CT imaging is frequently used to evaluate fractures of the shoulder, to assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [88]. CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [89]. CT scans have the disadvantage of being taken with the arm in the adducted position [39].

Ultrasound: Ultrasound is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [81]. Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [88]. Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [88]. Ultrasound can be useful in guiding injections or barbotage (aspirating calcific deposits in the rotator cuff) [81]. Ultrasonography can be used to measure the subacromial space and detect atrophy of rotator cuff muscles [88]. Ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [88].

Other Considerations: The acromiohumeral distance is normally 7 to 14 mm [89]. The width of the glenohumeral joint space should be symmetric superiorly and inferiorly [89]. The coracoclavicular distance is normally 1.1 to 1.3 cm [89]. Neer classified acromial morphology as type I (flat), type II (curved), and type III (hooked) [89]. Type III acromial morphology has been shown to have a correlation with the presence of rotator cuff disease; however, no direct causal relationship has been demonstrated [89]. The Neer classification of acromial morphology has shown relatively poor interobserver reliability [89].

Treatment

Non-Operative

Physical therapy is suggested as the first treatment for degenerative rotator cuff tears, with scapular dyskinesis addressed if present [5]. The aim of conservative treatment is to restore normal position and movement of the scapula and dynamic scapular stability during overhead activities [115]. However, non-surgical treatment involving rehabilitation of the scapula to an idealised normal posture is currently not supported by the available literature [102]. Both exercise interventions targeting the rotator cuff and scapular stabilizers are effective in terms of pain, function, and shoulder active range of motion in patients with subacromial syndrome [55]. Specific needs and muscle dysfunctions may vary between patients with subacromial pain, requiring individualized treatment goals and exercises based on thorough examination [46]. Postsurgical protocols must consider scapular dyskinesis to improve outcomes [5].

Operative

Indications: Surgical treatment of displaced fractures of the middle clavicle may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes [11]. Arthroscopic tenotomy is an effective surgical option for patients with painful shoulder and scapular dyskinesis due to pectoralis minor contracture when conservative treatment fails [113]. Combined serratus anterior plication and pectoralis minor release is a surgical option for refractory scapular dyskinesis with neurological involvement [47].

Postoperative Rehabilitation: Six months of rehabilitation treatment in the postoperative period is not enough to fully eliminate scapular dyskinesis following rotator cuff reconstruction [25]. Recovery of scapular dyskinesis postoperatively correlated with better function and successful rotator cuff healing [31].

Assessment and Clinical Implications

It is recommended to assess and treat scapular dyskinesis in patients with shoulder injury as it may increase dysfunction [14]. Scapular dyskinesis was associated with poorer clinical and functional outcomes and mediated the relationship between scapular endurance and functional status after rotator cuff repair [22]. Accounting for scapula dyskinesis in outcome measures leads to statistically different scores which cannot be predicted from standard measures without clinically relevant differences [36]. Scapular dyskinesis affects a significant number of patients following treatment of proximal humerus fractures [12].

Complications

Post-operative Kinematic Alterations

Scapular dyskinesis is a recognized postoperative complication following shoulder stabilization and arthroplasty. Following the Latarjet procedure, scapular dyskinesis occurs in 25% of patients [107], with one series observing the condition in 5 of 20 patients [13]. In a comparison of Latarjet versus pectoralis major release, dyskinesis occurred in 5 patients (25%) in the Latarjet group and none in the pectoralis major release group, with all cases presenting as Type III dyskinesis [58]. Conversely, surgical treatment of type III acute acromioclavicular joint dislocations is associated with a lower incidence of scapular dyskinesis and SICK scapula syndrome compared to historical studies on conservative treatment [59]. After total shoulder arthroplasty, scapular-predominant motion may reflect maladaptive kinematics resulting from residual stiffness, muscle dysfunction, implant malposition, or other factors [40].

Pre-operative and Associated Pathology

Abnormal scapular position, characterized by increased protraction, reduced upward scapular rotation, and loss of appropriate acromial elevation, may lead to compression of the rotator cuff under the acromial arch [10]. Scapular dyskinesis may also occur as a result of or in response to shoulder injury as a form of compensation [10].

Clinical Assessment and Diagnostic Challenges

The clinical utility of the scapular dyskinesis test is questioned in certain contexts. Functional impairment and outcomes did not differ between patients with or without the presence of scapular dyskinesis in subacromial impingement syndrome [15].

Outcomes and Rehabilitation

More than half of scapular dyskinesis cases, especially Type 1, improved postoperatively, with recovery correlating with better function and successful rotator cuff healing [31]. Early diagnosis may be useful for asymptomatic athletes with scapular dyskinesis to avoid its possible evolution to a symptomatic condition [27]. Accounting for scapula dyskinesis leads to statistically different scores in outcome measures which cannot be predicted from the Constant score without clinically relevant differences [36].

Recovery

Pathophysiology and Mechanisms: The cause-and-effect relationships between shoulder injuries and scapulothoracic kinematic abnormalities are not well-established, which complicates clinical management [10].

Post-Fracture Recovery: Surgical treatment may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes in patients with displaced fractures of the middle clavicle [11]. Surgical treatment of type III acute acromioclavicular dislocations is associated with a lower incidence of scapular dyskinesis and SICK scapula syndrome if compared to historical studies on conservative treatment [59].

Post-Rotator Cuff Repair Recovery: Six months of rehabilitation treatment in the postoperative period is not enough to fully eliminate scapular dyskinesis after rotator cuff reconstruction [25]. Recovery of scapular dyskinesis correlated with better function and successful rotator cuff healing [31].

Key Evidence

  • [L5] Scapular dyskinesis is a nonspecific response to shoulder dysfunction that should be suspected in patients with shoulder injury and can be identified and classified by specific physical examination. [1] (10.5435/00124635-200303000-00008)
  • [L5] The presence or absence of scapular dyskinesis needs to be determined during the clinical examination through visual inspection and objective posture measurements. [2] (10.1136/bjsm.2009.058834)
  • [L5] Scapular dyskinesis is a relatively new concept in the assessment of shoulder pathology and is likely a major contributor to shoulder pain, particularly in cases of recalcitrant shoulder pain and dysfunction. [3] (10.1177/1758573215595949)
  • [L5] Physical therapy is suggested as the first treatment for degenerative cuff tears, with scapular dyskinesis addressed if present, while postsurgical protocols must consider scapular dyskinesia to improve outcomes. [5] (10.1302/2058-5241.6.210043)
  • [L5] Treatment strategies for shoulder injury can be more effectively implemented by evaluation of the dyskinesis, and rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive shoulder rehabilitation programme. [6] (10.1136/bjsports-2013-092425)
  • [Paper] Scapular dyskinesis is a poorly understood condition that provides a challenge for the clinician in both diagnosis and management. [8] (10.1051/sicotj/2019029)
  • [L4] Scapular dyskinesis may represent normal movement variability. [9] (10.2519/jospt.2017.7268)
  • [Paper] [10] (10.1002/jor.22693)
  • [L3] Surgical treatment may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes. [11] (10.1016/j.jse.2015.05.047)
  • [L3] Scapular dyskinesis affects a significant number of patients following treatment of their proximal humerus fractures. [12] (10.1016/j.jse.2023.04.035)
  • [L3] Scapular dyskinesis was found in 5 of 20 patients who underwent a Latarjet procedure. [13] (10.1016/j.jse.2015.08.001)
  • [L2] Scapular dyskinesis may increase dysfunction in injured shoulders; therefore, it is recommended to assess and treat scapular dyskinesis in patients with shoulder injury. [14] (10.1016/j.jseint.2026.101643)
  • [L2] The findings that functional impairment and outcomes did not differ between patients with or without the presence of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. [15] (10.1016/j.jht.2017.04.002)
  • [L4] There is a lack of evidence for beneficial effects of exercise in improving scapular position and motion in individuals with scapular dyskinesis. [17] (10.1016/j.jse.2019.05.037)
  • [L4] Clinicians who considered scapular dyskinesis more important were more likely to classify it as present (OR = 1.42), while those seeing more shoulder patients weekly were less likely to do so (OR = 0.77). [18] (10.1177/17585732261424438)
  • [L1] [19] (10.1177/0363546520968508)
  • [L4] Shoulders visually judged as having dyskinesis showed distinct alterations in 3-dimensional scapular motion. [20] (10.4085/1062-6050-44.2.165)
  • [L3] Scapular dyskinesis was observed in 28.7% of the shoulders in asymptomatic European professional basketball players. [21] (10.1002/ksa.70060)
  • [Paper] Scapular dyskinesis was associated with poorer clinical and functional outcomes and mediated the relationship between scapular endurance and functional status. [22] (10.1371/journal.pone.0357765)
  • [L5] [23] (10.1007/s12178-019-09591-1)
  • [L5] Persistent scapular dyskinesis was observed after arthroscopic rotator cuff repair. [24] (10.1016/j.jseint.2025.101420)
  • [L2] Six months of rehabilitation treatment in the postoperative period is not enough to fully eliminate scapular dyskinesis. [25] (10.1002/jeo2.70154)
  • [L5] [26] (10.5435/jaaos-20-06-364)
  • [L3] Early diagnosis may be useful for asymptomatic athletes with scapular dyskinesis and to avoid its possible evolution to a symptomatic condition. [27] (10.1177/2325967117750814)
  • [L4] The mSAT should not be used solely for the assessment of scapular dyskinesis in clinical practice nor be influenced by the scapular dyskinesis test result. [28] (10.1016/j.jht.2023.07.004)
  • [L4] Clinically, scapular winging often mimics more common shoulder abnormalities and can result in unnecessary or unsuccessful surgical procedures. [29] (10.2106/jbjs.m.01031)
  • [L3] Kinematic analysis shows that asymmetries are common in symptomatic and asymptomatic populations. [30] (10.1016/j.arthro.2009.06.007)
  • [L4] More than half of the scapular dyskinesis cases, especially type 1, improved postoperatively, and recovery correlated with better function and successful rotator cuff healing. [31] (10.1007/s00167-021-06681-x)
  • [L2] A clinical evaluation of altered shoulder kinematics is still complicated. [32] (10.3390/ijerph17082974)
  • [L1] Measurement instruments to assess scapular dyskinesis are prone to misinterpretation and should therefore not be used as such. [33] (10.2519/jospt.2020.9265)
  • [L5] [34] (10.1177/1758573215618857)
  • [L4] Scapular dyskinesis identified during active motion did not result in different 3-D scapular orientation or acromiohumeral distance during active arm elevation in static positions; however, the SAT altered scapular kinematics and increased acromiohumeral distance. [35] (10.1016/j.jse.2011.01.008)
  • [L2] Results supported the hypotheses that CMS and SW-CMS are largely responsive to change and that accounting for scapula dyskinesis leads to statistically different scores which cannot be predicted from CMS without clinically relevant differences. [36] (10.1016/j.jelekin.2015.06.011)
  • [L3] Scapular-predominant motion may reflect maladaptive kinematics, potentially resulting from residual stiffness, muscle dysfunction, implant malposition, or other factors that may disrupt restoration of native physiological shoulder mechanics. [40] (10.1016/j.jse.2026.07.013)
  • [L3] Scapular kinematics and proprioception should be evaluated after ABR. [41] (10.1177/2325967120985207)
  • [L3] Patients after aTSA showed altered shoulder girdle kinematics and higher contribution of the shoulder girdle towards elevation. [42] (10.1016/j.gaitpost.2020.08.111)
  • [L4] Patients who reached at least 85° compensated for the loss of glenohumeral motion by increased scapulothoracic contribution, suggesting that structural damage interferes with motion mechanics. [43] (10.1016/j.jse.2016.02.031)
  • [L3] Scapular dyskinesis was found to have a greater reported prevalence (61%) in overhead athletes compared with nonoverhead athletes (33%). [44] (10.1177/2325967115627608)
  • [L4] The test for scapular dyskinesis showed satisfactory reliability for clinical use in a sample of overhead athletes known to be at increased risk for shoulder symptoms. [45] (10.4085/1062-6050-44.2.160)
  • [L5] [46] (10.1016/j.jht.2017.03.006)
  • [L4] [47] (10.1016/j.jse.2026.01.018)
  • [L4] Scapular dyskinesia caused by tumors in the scapulothoracic joint may result in subacromial impingement syndrome, and pain and impingement signs disappeared after tumor excision without specific intervention to treat the subacromial pathology. [49] (10.1007/s00167-011-1805-5)
  • [L4] [50] (10.1371/journal.pone.0181518)
  • [L2] [52] (10.1177/2325967118799308)
  • [L1] Both interventions are effective in terms of pain, function, and shoulder active range of motion. [55] (10.1016/j.jht.2017.11.041)
  • [L3] It appears that scapular kinematics and impairment features can be used to classify subjects with SAIS in addition to self-report. [56] (10.1016/j.math.2010.06.003)
  • [L3] Scapular dyskinesis occurred in 5 TL patients (25%) and none in the PMRL group; in all cases, a Type III dyskinesis was present. [58] (10.1016/j.jseint.2025.101510)
  • [L4] Surgical treatment of type III acute AC joint dislocations is associated with a lower incidence of scapular dyskinesis and SICK scapula syndrome if compared to historical studies on conservative treatment. [59] (10.1007/s00167-012-1959-9)
  • [L3] [61] (10.1016/j.jse.2017.12.032)
  • [L4] Our results suggest that clavicle shortening of >10% greatly affects scapular kinematics in vivo. [94] (10.1016/j.jse.2017.03.013)
  • [L3] The Y-N is reliable in detecting scapular dyskinesis in asymptomatic individuals regardless of experience. [97] (10.5397/cise.2022.01109)
  • [L3] This study shows that demonstrated apparent supraspinatus weakness on clinical examination in symptomatic patients may be dependent on scapular position. [98] (10.1177/0363546506288728)
  • [L4] Although the supraspinatus and infraspinatus do not directly control the movement of the scapula, they appear to result in a compensatory change in scapular motion. [100] (10.1016/j.clinbiomech.2006.02.001)
  • [L2] Non-surgical treatment involving rehabilitation of the scapula to an idealised normal posture is currently not supported by the available literature. [102] (10.1136/bjsports-2013-092389)
  • [L3] Increasing severity of glenohumeral osteoarthritis leads to a reduced motion of the glenohumeral joint, while the magnitude of the scapulothoracic motion increases. [103] (10.1016/j.otsr.2019.07.010)
  • [L1] There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following TSA compared to asymptomatic shoulders. [104] (10.1016/j.jse.2025.08.010)
  • [L3] The study confirmed that postoperative scapular dyskinesis occurs frequently (25%) after the Latarjet procedure. [107] (10.1177/03635465251332270)
  • [L1] Scapular motion is abnormal in the presence of a rotator cuff tear, but the literature is inconsistent regarding a universally affected variable or consistent degree of scapular dysfunction. [108] (10.1016/j.jse.2020.12.012)
  • [L4] Chronic type III AC dislocation causes scapular dyskinesis in 70.6% of patients, of whom 58.3% have SICK scapula syndrome develop. [109] (10.1016/j.arthro.2008.08.019)
  • [L1] This study found that RSA shoulders have an increased contribution of ST joint during arm elevation, compared with asymptomatic shoulders. [111] (10.1016/j.xrrt.2021.10.009)
  • [L3] Scapulothoracic motion is more complex than previously reported, especially in patients with rotator cuff arthropathy, with a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation. [112] (10.1097/corr.0000000000001406)
  • [L4] When conservative treatment fails, arthroscopic tenotomy is an effective surgical option for patients with painful shoulder and scapular dyskinesis due to pectoralis minor contracture. [113] (10.1016/j.jse.2025.12.012)
  • [L5] The aim of conservative treatment is to restore normal position and movement of the scapula and furthermore dynamic scapular stability during overhead activities. [115] (10.1007/s11678-015-0344-y)

See Also

References

[1] Scapular Dyskinesis and Its Relation to Shoulder Pain. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200303000-00008

[2] Current concepts: scapular dyskinesis. British Journal of Sports Medicine. 2009. DOI: 10.1136/bjsm.2009.058834

[3] Scapular dyskinesis: the surgeon’s perspective. Shoulder & Elbow. 2015. DOI: 10.1177/1758573215595949

[5] The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.210043

[6] Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’. British Journal of Sports Medicine. 2013. DOI: 10.1136/bjsports-2013-092425

[8] Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT-J. 2019. DOI: 10.1051/sicotj/2019029

[9] Observational Scapular Dyskinesis: Known-Groups Validity in Patients With and Without Shoulder Pain. Journal of Orthopaedic & Sports Physical Therapy. 2017. DOI: 10.2519/jospt.2017.7268

[10] Scapular dyskinesis is detrimental to shoulder tendon properties and joint mechanics in a rat model. Journal of Orthopaedic Research. 2014. DOI: 10.1002/jor.22693

[11] Scapular dyskinesis following displaced fractures of the middle clavicle. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.047

[12] Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.04.035

[13] Scapular dyskinesis after Latarjet procedure. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.001

[14] Prevalence and grade of scapular dyskinesis in patients with shoulder injuries: a cross-sectional study. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101643

[15] The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2017.04.002

[17] Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.05.037

[18] Clinicians who think scapular dyskinesis is important are more likely to identify it in healthy individuals. Shoulder & Elbow. 2026. DOI: 10.1177/17585732261424438

[19] Scapular Dyskinesis Is Not an Isolated Risk Factor for Shoulder Injury in Athletes: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520968508

[20] A Clinical Method for Identifying Scapular Dyskinesis, Part 2: Validity. Journal of Athletic Training. 2009. DOI: 10.4085/1062-6050-44.2.165

[21] Scapular dyskinesis is common among asymptomatic European basketball players at the professional level. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70060

[22] Scapular endurance, dyskinesis, and functional outcomes after rotator cuff repair: A cross-sectional mediation analysis. PLOS One. 2026. DOI: 10.1371/journal.pone.0357765

[23] Evaluation and Management of Scapular Dyskinesis in Overhead Athletes. Current Reviews in Musculoskeletal Medicine. 2019. DOI: 10.1007/s12178-019-09591-1

[24] Persistent scapular dyskinesis after arthroscopic rotator cuff repair: a prospective study. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101420

[25] Scapula dyskinesis in medium‐sized full‐thickness rotator cuff tear after subacromial Lidocaine infiltration and rotator cuff reconstruction. Journal of Experimental Orthopaedics. 2025. DOI: 10.1002/jeo2.70154

[26] Scapular Dyskinesis and Its Relation to Shoulder Injury. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-06-364

[27] Scapular Dyskinesis in Young, Asymptomatic Elite Swimmers. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967117750814

[28] Prevalence of positive modified scapular assistance test in patients with shoulder pain with and without scapular dyskinesis: a cross-sectional study. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.07.004

[29] Scapular Winging: A Great Masquerader of Shoulder Disorders. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01031

[30] Evaluation of Clinical Assessment Methods for Scapular Dyskinesis. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.06.007

[31] Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06681-x

[32] Scapular Dyskinesis: From Basic Science to Ultimate Treatment. International Journal of Environmental Research and Public Health. 2020. DOI: 10.3390/ijerph17082974

[33] Validity of Clinical Measurement Instruments Assessing Scapular Function: Insufficient Evidence to Recommend Any Instrument for Assessing Scapular Posture, Movement, and Dysfunction—A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2020. DOI: 10.2519/jospt.2020.9265

[34] Scapular dyskinesia: evolution towards a systems-based approach. Shoulder & Elbow. 2015. DOI: 10.1177/1758573215618857

[35] Effects of scapular dyskinesis and scapular assistance test on subacromial space during static arm elevation. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.01.008

[36] The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure. Journal of Electromyography and Kinesiology. 2016. DOI: 10.1016/j.jelekin.2015.06.011

[39] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[40] Total Shoulder Arthroplasty and Scapulohumeral Rhythm: The clinical impact of achieving native shoulder mechanics. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.07.013

[41] Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967120985207

[42] Scapulohumeral rhythm in patients after total shoulder arthroplasty compared to age-matched healthy individuals. Gait & Posture. 2020. DOI: 10.1016/j.gaitpost.2020.08.111

[43] Scapulohumeral rhythm relative to active range of motion in patients with symptomatic rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.031

[44] Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967115627608

[45] A Clinical Method for Identifying Scapular Dyskinesis, Part 1: Reliability. Journal of Athletic Training. 2009. DOI: 10.4085/1062-6050-44.2.160

[46] Scapular muscle dysfunction associated with subacromial pain syndrome. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2017.03.006

[47] Combined serratus anterior plication and pectoralis minor release improves clinical outcomes in refractory scapular dyskinesis with neurological involvement. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.018

[49] Subacromial impingement syndrome secondary to scapulothoracic dyskinesia. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1805-5

[50] Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLOS ONE. 2017. DOI: 10.1371/journal.pone.0181518

[52] Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118799308

[55] Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome. Journal of Hand Therapy. 2018. DOI: 10.1016/j.jht.2017.11.041

[56] Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome. Manual Therapy. 2010. DOI: 10.1016/j.math.2010.06.003

[58] The “Pectoralis Minor Repairing Latarjet”: a modified technique to prevent postoperative scapular dyskinesis after Latarjet procedure. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101510

[59] Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-1959-9

[61] A preliminary exploration of plain-film radiography in scapular dyskinesis evaluation. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.12.032

[64] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[66] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[67] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[74] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Development of Individual Regions.

[77] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE-PATELLAR TENDON-BONE GRAFT > SHOULDER INJURIES > ANATOMY AND BIOMECHANICS.

[78] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > UPPER EXTREMITY > SHOULDER.

[81] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[84] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[86] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Magnetic Resonance Imaging and Arthrography.

[88] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging > Clinical Evaluation > Imaging.

[89] Aaos Comprehensive Orthopaedic Review 3. Imaging of the Shoulder and Elbow > I. Shoulder.

[94] Effects of short malunion of the clavicle on in vivo scapular kinematics. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.03.013

[97] Reliability of the scapular dyskinesis test yes-no classification in asymptomatic individuals between students and expert physical therapists. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2022.01109

[98] Evaluation of Apparent and Absolute Supraspinatus Strength in Patients with Shoulder Injury Using the Scapular Retraction Test. The American Journal of Sports Medicine. 2006. DOI: 10.1177/0363546506288728

[100] Suprascapular nerve block disrupts the normal pattern of scapular kinematics. Clinical Biomechanics. 2006. DOI: 10.1016/j.clinbiomech.2006.02.001

[102] Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. British Journal of Sports Medicine. 2013. DOI: 10.1136/bjsports-2013-092389

[103] Variation of the glenohumeral and scapulothoracic motion in progressive severity of glenohumeral osteoarthritis. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.07.010

[104] Impact of reverse total shoulder arthroplasty on scapulohumeral rhythm: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.08.010

[107] The Pectoralis Minor–Repairing Latarjet: A Modified Technique to Prevent Postoperative Scapular Dyskinesis After the Latarjet Procedure. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251332270

[108] Scapular motion in the presence of rotator cuff tears: a systematic review. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.12.012

[109] Scapular Dyskinesis and SICK Scapula Syndrome in Patients With Chronic Type III Acromioclavicular Dislocation. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.08.019

[111] Three-dimensional kinematic evaluation of scapulohumeral rhythm after reverse shoulder arthroplasty: a systematic review and meta-analysis. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2021.10.009

[112] How Do Scapulothoracic Kinematics During Shoulder Elevation Differ Between Adults With and Without Rotator Cuff Arthropathy?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001406

[113] Pectoralis minor tenotomy in the treatment of painful shoulder syndromes associated with scapular dyskinesis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.012

[115] Effective rehabilitation in patients with scapular dyskinesis. Obere Extremität. 2016. DOI: 10.1007/s11678-015-0344-y

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h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.