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The Role of the Scapula in Shoulder Pain

The scapula, or shoulder blade, is a large triangular-shaped bone that lies in the upper back. The bone is surrounded and supported by a complex system of muscles that work together to help you move your arm.

If an injury or condition causes these muscles to become weak or imbalanced, it can alter the position of the scapula at rest or in motion.

An alteration in scapular positioning or motion can make it difficult to move your arm, especially when performing overhead activities, and may cause your shoulder to feel weak.

Disorders of the scapula result in a deviation, or alteration, in the:

  • Normal resting position of the scapula, or

  • Normal motion of the scapula as the arm moves

The medical term for these alterations is scapular dyskinesis.

Causes of scapular dyskinesis include:

  • Weakness, imbalance, tightness, or detachment of the muscles that control the scapula.

  • Injuries to the nerves that supply the muscles.

  • Injuries to the bones that support the scapula or injuries within the shoulder joint.

The most common symptoms of scapular dyskinesis include:

  • Pain and/or tenderness around the scapula, especially on the top and medial (inner) border

  • Weakness in the affected arm—your arm may feel "tired" or "dead" when you try to use it vigorously

  • Fatigue with repetitive activities, especially overhead movements

  • Limited range of motion—you may be unable to raise your arm above shoulder height

  • Noticeable protrusion or "winging" of the scapula

  • A drooped or forward tilted posture on the affected side.

At a basic level, treatment of scapular dyskinesis includes retraining the muscles of the upper limb to restore optimal posture.

As you perform your everyday activities, try to stand and sit with good posture.

To do this, pull your shoulder blades back together (as if you are squeezing a golf ball between the shoulderblades), and bend your elbows down and back as if you are trying to put them in your back pockets.

If you are in a regular exercise program, make sure your upper body strength sessions are balanced. For every set of "presses" that you perform, you should do one set of "flys" and two sets of "rows." Your program should also include stretching exercises for your front shoulder muscles and for shoulder joint rotation.

NB - You should always contact a Chartered Physiotherapist for guidance with a rehabilitation programme.

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