Evaluation and management of scapulothoracic disorders

Abstract

Purpose of review: Normal scapular motion is closely integrated with arm motion to provide efficient scapulohumeral rhythm in shoulder function. Proper positioning of the scapula is required for stabilization of the glenohumeral joint and for efficient transfer of force by the shoulder. There are many common shoulder pathologies that are associated with scapular dyskinesis. Thorough evaluation and treatment of these disorders requires an understanding of the scapula in shoulder dysfunction. Recent findings: Scapulothoracic dysfunction may be caused by bony malalignment, muscular imbalance or a loss of protraction/retraction control. Management of scapulothoracic dysfunction requires appropriate treatment of proximal or distal causes and the subsequent restoration of normal scapulohumeral kinematics through physical therapy regimens that focus on flexibility and closed chain exercises. Rehabilitation is the primary management of scapular disorders. Rare cases of scapular disorders may require surgical management, including snapping scapula and serratus anterior palsy that are refractory to rehabilitation. Summary: A thorough understanding of the kinematics of scapula motion and how the scapula interacts with the various bony and muscular components of the shoulder is necessary for appropriate management of a wide variety of shoulder disorders. This review provides an introduction to the components of scapulothoracic dysfunction and its management.