Scapulothoracic Dysfunction: Cause or Innocent Bystander in Shoulder Complaints?

An Update – Prof. Ann Cools

The scapula plays a central role in the function of the upper limb. During arm movements, the scapula must continuously follow the position of the humeral head to ensure optimal joint mechanics. This makes the scapula an essential link in the kinetic chain between the trunk and the arm.

Among other functions, the scapula contributes to:

• maintaining sufficient acromiohumeral space,
• preserving the optimal length–tension relationship of the deltoid and rotator cuff,
• providing a stable fulcrum for the humeral head within the glenoid,
• and transferring kinetic energy from the trunk to the upper limb.

Despite its importance, the exact role of scapular dysfunction in shoulder disorders remains a topic of ongoing debate. The scientific literature shows no clear consensus on whether scapular abnormalities represent a cause of shoulder pain, a consequence of it, or simply a variation of normal movement patterns.

Research demonstrates, for example, that asymmetry in scapular movement is also present in asymptomatic athletes: up to 61% in overhead athletes and approximately 33% in non-overhead athletes. This indicates that not every deviation in scapular movement should automatically be interpreted as pathological.

At the same time, studies suggest that in some patients with shoulder complaints specific changes in scapular kinematics and muscle activity may occur, such as:

• decreased upward rotation,
• decreased posterior tilt,
• decreased external rotation,
• increased activity of the upper trapezius,
• reduced activity of the lower trapezius and serratus anterior,
• and increased activity of the pectoralis minor.

This webinar provides an up-to-date overview of current scientific insights and their translation into clinical practice.

During this webinar we will discuss

1. The role of the scapula in shoulder pain

• What is the function of the scapula in normal movement patterns?
• When is scapular dyskinesis clinically relevant?
• Is scapular dysfunction a cause or a consequence of shoulder complaints?
• When is the scapula a relevant contributor, and when merely an innocent bystander?

2. Clinical examination of scapular dysfunction

• The value of visual observation during clinical examination
• The role and limitations of measurement tools for scapular position and function
• Practical clinical tests that help identify scapular involvement in shoulder complaints

3. Rehabilitation of scapular dysfunction

Based on recent research findings, practical principles for scapular rehabilitation will be discussed, including:

• promoting posterior tilt and upward rotation,
• optimizing muscle balance around the scapula,
• reducing overactivity of muscles such as the pectoralis minor, levator scapulae and rhomboids,
• and strengthening key stabilizers such as the lower trapezius and serratus anterior.

Who is this webinar for?

This webinar is designed for physiotherapists, manual therapists, and other healthcare professionals who work with patients with shoulder disorders and wish to deepen their clinical reasoning regarding scapular dysfunction based on current scientific insights.

Learning Objectives

After completing this webinar, participants will be able to:

1. Critically analyse the role of the scapula in shoulder function and shoulder pain.

Participants will be able to explain the biomechanical and functional contribution of the scapula within the shoulder complex and the kinetic chain, including its role in maintaining acromiohumeral space, optimising the length–tension relationship of the rotator cuff and deltoid, and facilitating efficient force transfer during upper limb movements.

2. Evaluate the current scientific evidence regarding scapular dyskinesis and shoulder disorders.

Participants will be able to interpret research findings on scapular kinematics, muscle activation patterns, and the potential cause–consequence relationship between scapular dysfunction and shoulder pain, and integrate these insights into clinical reasoning.

3. Perform and interpret a structured clinical examination of scapular function.

Participants will be able to apply visual observation, symptom-modification tests, and additional clinical assessment strategies to evaluate potential scapular involvement in shoulder complaints, while recognising the limitations of current measurement tools and diagnostic tests.

4. Formulate evidence-informed clinical hypotheses regarding the role of the scapula in individual shoulder complaints.

Participants will be able to integrate patient history, clinical examination findings, and movement analysis to determine whether scapular dysfunction likely represents a primary cause, a secondary adaptation, or a clinically less relevant observation in a specific patient.

5. Design targeted exercise therapy for scapular rehabilitation based on principles of muscle balance and movement control.

Participants will be able to select and justify appropriate therapeutic exercise interventions aimed at optimising scapular kinematics and muscle coordination, including strategies to enhance activation of the lower trapezius and serratus anterior and reduce excessive activity of muscles such as the pectoralis minor or levator scapulae.

Accreditation

This webinar is accredited by Kwaliteitshuis Fysiotherapie (KNGF and Keurmerk) and PQK.