{"id":12431,"date":"2022-11-01T13:01:53","date_gmt":"2022-11-01T12:01:53","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=wiki&amp;p=12431"},"modified":"2022-11-01T13:01:53","modified_gmt":"2022-11-01T12:01:53","slug":"scapular-alignment","status":"publish","type":"wiki","link":"https:\/\/www.physiotutors.com\/wiki\/scapular-alignment\/","title":{"rendered":"Scapular Alignment"},"featured_media":12432,"template":"","class_list":["post-12431","wiki","type-wiki","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":12432,"background_image_alt_text":"Scapular Alignment"},"heading":"Scapular Alignment | Scapular Dyskinesis Assessment","subheading":"Shoulder Assessment","content_editor":"","button_type":"url","button_label":"Check our shop","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/rotator-cuff-related-shoulder-pain\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Online Course","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":""},"button_description":"Find this wiki on the Physiotutors platform"},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h6>Scapular Alignment | Scapular Dyskinesis Assessment<\/h2>\n<span style=\"font-weight: 400;\">The literature commonly describes normal shoulder girdle alignment with the following criteria.\u00a0<\/span>\n\n<span style=\"font-weight: 400;\">Shoulder height lies slightly below the level of spinous process T1 and if viewed from the side the plumb line runs centrally through the acromion.\n<\/span><span style=\"font-weight: 400;\">Impaired alignment of the shoulder girdle can manifest as elevation, which can be seen from behind, o<\/span><span style=\"font-weight: 400;\">r depression when the superior angle of the scapula lies below T2, or when looking at the patient from the front showing in a more horizontal orientation of the clavicle or an AC joint that lies below the SC joint.<\/span>\n\n<span style=\"font-weight: 400;\">Thirdly, an increasingly more prevalent misalignment is that of a protracted shoulder girdle.\n<\/span><span style=\"font-weight: 400;\">Normal scapula position usually consists of the superior angle being at spinal level T2 and the inferior angle at T7.\nThe medial border runs parallel to the spine at a distance of 3 inches of 7,5cm, which is roughly the width of four fingers.\u00a0<\/span>\n\n<span style=\"font-weight: 400;\">The Scapula lies flat on the thorax with a 30\u00b0 anterior rotation to the frontal plane.\n<\/span><span style=\"font-weight: 400;\">The scapula has four possible movement directions. (<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25749493\/\" target=\"_blank\" rel=\"noopener\">O'Leary et al 2015<\/a>):<\/span>\n\n<img class=\"aligncenter size-full wp-image-12433\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/Scapular-movement.jpg\" alt=\"Scapular movement\" width=\"746\" height=\"250\" \/>\n\n<span style=\"font-weight: 400;\">Muscles attaching around the scapula:<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">M.trapezius &amp; M.serratus anterior = force couple<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">descendens &amp; pars inferior Serratus: upward rotation<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">ascendens: upward into caudomedial direction (posterior tilt)<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">transversa: adduction<\/span><\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">pars superior Serratus = antagonist to pars inferior<\/span><\/li>\n<\/ul>\n<\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">M.levator scapulae:<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">downward rotation &amp; cranial medial<\/span><\/li>\n<\/ul>\n<\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mm.rhomboidei:\u00a0<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">downward rotation &amp; adduction<\/span><\/li>\n<\/ul>\n<\/li>\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">M. pectoralis minor:\u00a0<\/span>\n<ul>\n \t<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">downward rotation &amp; anterior tilt<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"embed-container\">\n\n[embed]https:\/\/www.youtube.com\/watch?v=n2HN3AAepwE[\/embed]\n\n<\/div>\n<span style=\"font-weight: 400;\">Deficiencies or overactivity in one or more of these muscles can lead to impaired alignment.<\/span>\n\n<span style=\"font-weight: 400;\">In a downward rotated scapula, the inferior angle will be positioned more medial to the spine than the superior angle. Oftentimes, this is caused by a shortened levator and\/or rhomboid muscle with or without a lengthened trapezius pars descendens and maybe also serratus anterior weakness.<\/span>\n\n<img class=\"aligncenter size-full wp-image-12434\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/downward-rotated-scapula.jpg\" alt=\"Downward rotated scapula\" width=\"1914\" height=\"1070\" \/>\n\n<span style=\"font-weight: 400;\">If the scapula is depressed so it is positioned below the common area between T2-7 the reason might be a shortened pectoralis major or latissimus dorsi and or a lengthed trapezius pars descendens.<\/span>\n\n<img class=\"aligncenter size-full wp-image-12435\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/Depressed-scapula.jpg\" alt=\"Depressed scapula\" width=\"1918\" height=\"1071\" \/>\n\n<span style=\"font-weight: 400;\">A more elevated scapula can have multiple causes. If just the superior angle lies above the AC joint, the reason might be a short levator scapula. <\/span>\n\n<img class=\"aligncenter size-full wp-image-12436\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/elevated-scapula.jpg\" alt=\"Elevated scapula\" width=\"1919\" height=\"1063\" \/>\n\n<span style=\"font-weight: 400;\">If the AC joint is elevated as well then the trapezius pas descendens might be more involved.\u00a0<\/span>\n\n<img class=\"aligncenter size-full wp-image-12437\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/Elevated-superior-angle-and-ACJ.jpg\" alt=\"Elevated superior angle and acj\" width=\"1912\" height=\"1065\" \/>\n\n<span style=\"font-weight: 400;\">If the entire scapular spine is elevated then the above plus rhomboids might all be shortened.<\/span>\n\n<img class=\"aligncenter size-full wp-image-12442\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/scapula-elevation_complete.jpg\" alt=\"Scapula elevation complete\" width=\"1910\" height=\"1059\" \/>\n\n<span style=\"font-weight: 400;\">In increased adduction, meaning the distance between the spine and the medial border is smaller than 3 inches or 7,6cm,\u00a0 possible reasons for the misalignment could be shortened rhomboids or trapezius pars descendens, or a lengthened\/weak serratus anterior-<\/span>\n\n<img class=\"aligncenter size-full wp-image-12439\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/scapula-adduction.jpg\" alt=\"Scapula adduction\" width=\"1915\" height=\"1074\" \/>\n\n<span style=\"font-weight: 400;\">On the other hand, if the scapula presents more abducted showing a more anteriorly oriented glenoid and a distance between the spine and medial border larger than 3inches the cause can be a shortened serratus anterior and\/or pectoralis major.<\/span>\n\n<img class=\"aligncenter size-full wp-image-12438\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/scapula-protraction.jpg\" alt=\"Scapula protraction\" width=\"1909\" height=\"1070\" \/>\n\n<span style=\"font-weight: 400;\">In these pictures, you can see a winging scapula or scapula alata. The medial border is very prominent and lifts off of the thorax. Often times weakness of the serratus anterior can be caused by a compromised long thoracic nerve. Furthermore, a flat thoracic spine or hyperkyphosis, scoliosis, and hypertrophy of the subscapularis might be reasons for a winging scapula.<\/span>\n\n<img class=\"aligncenter size-full wp-image-12440\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/winging-scapula.jpg\" alt=\"Winging scapula\" width=\"1907\" height=\"1074\" \/>\n\n<span style=\"font-weight: 400;\">When the inferior angle of the scapula lifts off of the thorax we are talking about a tilted or tipped scapula. Predominantly, shortened muscles attaching to the coracoid process like the pectoralis minor, the short head of the biceps brachii, or coracobrachialis can cause a tilt.<\/span>\n\n<img class=\"aligncenter size-full wp-image-12441\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/tilted-scapula.jpg\" alt=\"Tilted scapula\" width=\"1913\" height=\"1057\" \/>\n\nHere's an overview about the impairments and possible causes:\n\n<img class=\"aligncenter size-full wp-image-12444\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/11\/Alignment-overview.jpg\" alt=\"Alignment overview\" width=\"521\" height=\"543\" \/>\n\n[cta]\n\nIf you're curious about further tests to assess the scapula, check out the following:\n<ul>\n \t<li><a href=\"https:\/\/www.physiotutors.com\/wiki\/scapulohumeral-rythm\/\">Scapulohumeral Rhythm<\/a><\/li>\n \t<li><a href=\"https:\/\/www.physiotutors.com\/wiki\/scapular-dyskinesis-test\/\">Scapular Dyskinesis Test<\/a><\/li>\n \t<li><a href=\"https:\/\/www.physiotutors.com\/wiki\/scapular-assistance-test\/\">Scapular Assistance Test (SAT)<\/a><\/li>\n \t<li><a href=\"https:\/\/www.physiotutors.com\/wiki\/scapular-retraction-test\/\">Scapular Resistance Test (SRT)<\/a><\/li>\n<\/ul>\n&nbsp;\n"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>References<\/h4>"},"column_right":{"content_editor":"<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25749493\/\" target=\"_blank\" rel=\"noopener\">O\u2019Leary, S., Christensen, S. W., Verouhis, A., Pape, M., Nilsen, O., &amp; McPhail, S. M. (2015). Agreement between physiotherapists rating scapular posture in multiple planes in patients with neck pain: Reliability study.\u00a0<i>Physiotherapy<\/i>,\u00a0<i>101<\/i>(4), 381-388.<\/a>\n\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2657032\/\" target=\"_blank\" rel=\"noopener\">Tate, A. R., McClure, P., Kareha, S., Irwin, D., &amp; Barbe, M. F. (2009). A clinical method for identifying scapular dyskinesis, part 2: validity.\u00a0<i>Journal of athletic training<\/i>,\u00a0<i>44<\/i>(2), 165-173.<\/a>"}},{"acf_fc_layout":"cta-image-v2","layout":"","background":"transparent","heading":"","content_editor":"<p class=\"subheading\">Like what you\u2019re learning?<\/p>\n<p class=\"heading-two\">BUY THE FULL PHYSIOTUTORS <strong>ASSESSMENT BOOK<\/strong><\/p>\n\n<ul>\n \t<li>600+ Pages e-Book<\/li>\n \t<li>Interactive Content (Direct Video Demonstration, PubMed articles)<\/li>\n \t<li>Statistical Values for all Special Tests from the latest research<\/li>\n \t<li>Available in \ud83c\uddec\ud83c\udde7 \ud83c\udde9\ud83c\uddea \ud83c\uddeb\ud83c\uddf7 \ud83c\uddea\ud83c\uddf8 \ud83c\uddee\ud83c\uddf9 \ud83c\uddf5\ud83c\uddf9 \ud83c\uddf9\ud83c\uddf7<\/li>\n \t<li>And much more!<\/li>\n<\/ul>","button_type":"internal_link","button_label":"Check out our 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