The scapula, or shoulder blade is an integral part of the entire shoulder complex serving as the foundation for properly functioning shoulders. Often times, dysfunctions can occur with shoulder blade movement that can be related to shoulder pain that requires strengthening and stability training to help decrease shoulder pain. Physical therapists will often observe shoulder blade positioning in a resting position with arms by side, arms elevated, or with hands on hips. It is also beneficial to assess shoulder blade movement when raising arms up overhead in different planes of motion with and without holding weights. The following are shoulder blade anatomical structures that physical therapists look at to help determine shoulder blade dysfunctions:
Inferior Angle: If the lower angle of the shoulder blade is very prominent, this may be due to forward tipping of the shoulder blade. This is commonly seen in patients with rotator cuff impingement as this causes the acromion to be in a position to potentially get in the way of the elevating humeral head.
Medial Border: If the inner border of the shoulder blade becomes more displaced away from the body, this may be due to internal rotation of the shoulder blade. This is commonly seen in patients with shoulder joint instability. Due to the internal rotated position of the shoulder blade, this can cause an altered position of the glenoid (the socket of the shoulder) for the humeral head (the ball of the shoulder) to be centered in it and may lead to increased risk for shoulder instability or partial dislocations.
Superior Angle: This is when we look at the top of the shoulder blade and see if the shoulder blade moves upward early and excessively when elevating the arm overhead. This may be a sign of rotator cuff weakness and force couple imbalance between the muscles that move and stabilize the shoulder blade.
Physical therapists may also perform clinical tests for the shoulder blade to help them determine their treatment plan. The following are an explanation of some clinical tests for shoulder blade functioning:
Scapular Assistance Test: the clinician will provide manual assistance with one hand at the lower angle and the other hand at the top of the shoulder blade providing an upward rotation assistance to the shoulder blade while patient is actively raising their arm overhead. If patient elevates their arm with decreased pain or achieves greater range of motion, then it is a positive test and patients can benefit from exercises to improve their scapular muscle control.
Scapular Retraction Test: the clinician will manually retract the patient’s shoulder blade when they perform a pain provoking movement. This test has shown kinematic changes that places the glenohumeral joint (shoulder) in a more favorable position for functional movements. If a decrease in pain occurs, then this is a positive test and the patient will benefit from improving shoulder blade retraction exercises while moving their arms in different positions.
Flip Sign: when assessing shoulder external rotation strength, the clinician will observe the inner border of the shoulder blade. If the medial border becomes more prominent during the resisted external rotation movement, then this is a positive test that indicates a possible loss of scapular stability. It would be beneficial for the patient to improve their serratus anterior and trapezius force couple.
Using these clinical tests and assessing for shoulder blade functioning provides physical therapists with a better understanding of our patient’s shoulder conditions and helps us develop the proper treatment plan. Improving stability of the shoulder blades can be extremely helpful to decrease shoulder pain and improve functional abilities. If you have shoulder pain, give Physical Therapy First a call. We provide 1 on 1, hour long sessions to address your goals and get you moving in the right direction.
Ellenbecker T, Manske R, Kelley, M. Current Concepts of Orthopaedic Physical Therapy: The Shoulder: Physical Therapy Patient Management Using Current Evidence. 4th Edition. Orthopedic Section, APTA 2016