Scapular Dyskinesia: Difference between revisions

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=== Manually Assisted Movements of Scapula ===
=== Manually Assisted Movements of Scapula ===
This step consists of two tests: [[Scapular Assistance Test|The Scapular Assistance Test]] (SAT) and [[Scapular Retraction Test|The Scapular Reposition (Retraction) Test]] (SRT). These tests, in which manual assistance is applied to the scapula, are provocation tests that evaluate the role of the scapula position in shoulder pain. <ref>Kopkow C, Lange T, Schmitt J, Kasten P. [https://pubmed.ncbi.nlm.nih.gov/25935796/ Interrater reliability of the modified scapular assistance test with and without handheld weights.] Manual therapy. 2015 Dec 1;20(6):868-74.</ref>
To determine the role of the scapula position in shoulder pain two tests that apply manual assistance to the scapula are [[Scapular Assistance Test|The Scapular Assistance Test]] (SAT) and [[Scapular Retraction Test|The Scapular Reposition (Retraction) Test]] (SRT). <ref>Kopkow C, Lange T, Schmitt J, Kasten P. [https://pubmed.ncbi.nlm.nih.gov/25935796/ Interrater reliability of the modified scapular assistance test with and without handheld weights.] Manual therapy. 2015 Dec 1;20(6):868-74.</ref>


While performing SAT the patient is asked to elevate the arm in the sagittal plane and rate the shoulder pain on the 11-point numerical pain rating scale. Then, asked to do the same while the examiner pushes upward and laterally on the inferior angle, and pulls the superior aspect of the scapula (to produce posterior tilt). A decrease in shoulder pain of two or more points after assisted motion is considered a positive test. Usually, it is positive in patients with painful arc or shoulder impingement. There are no false positives in asymptomatic patients. <ref>Kibler WB, Sciascia AD. [https://pubmed.ncbi.nlm.nih.gov/23580419/ Introduction to the second international conference on scapular dyskinesis in shoulder injury—the ‘Scapular summit’report of 2013.] British journal of sports medicine. 2013 Sep 1;47(14):874-.
In the SAT, the patient is asked to elevate the arm in sagittal plane and rate the pain on the 11-point numerical pain rating scale. The same process is repeated while the examiner pushes upward and laterally on the inferior angle, and pulls the superior aspect of the scapula (to produce posterior tilt). If two or more points of pain decrease after assisted movement, the test is positive. <ref>Kibler WB, Sciascia AD. [https://pubmed.ncbi.nlm.nih.gov/23580419/ Introduction to the second international conference on scapular dyskinesis in shoulder injury—the ‘Scapular summit’report of 2013.] British journal of sports medicine. 2013 Sep 1;47(14):874-.
</ref><ref>Kibler BW, McMullen J. [https://pubmed.ncbi.nlm.nih.gov/12670140/ Scapular dyskinesis and its relation to shoulder pain.] JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2003 Mar 1;11(2):142-51.</ref><ref>Kibler WB. [https://pubmed.ncbi.nlm.nih.gov/21986043/ The scapula in rotator cuff disease.] Rotator Cuff Tear. 2012;57:27-40.</ref><ref>Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. [https://pubmed.ncbi.nlm.nih.gov/17017270/ The intertester reliability of the scapular assistance test.] Journal of Orthopaedic & Sports Physical Therapy. 2006 Sep;36(9):653-60.</ref><ref>Rabin A, Chechik O, Dolkart O, Goldstein Y, Maman E. [https://pubmed.ncbi.nlm.nih.gov/30268967/ A positive scapular assistance test is equally present in various shoulder disorders but more commonly found among patients with scapular dyskinesis.] Physical Therapy in Sport. 2018 Nov 1;34:129-35.</ref>  
</ref><ref>Kibler BW, McMullen J. [https://pubmed.ncbi.nlm.nih.gov/12670140/ Scapular dyskinesis and its relation to shoulder pain.] JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2003 Mar 1;11(2):142-51.</ref><ref>Kibler WB. [https://pubmed.ncbi.nlm.nih.gov/21986043/ The scapula in rotator cuff disease.] Rotator Cuff Tear. 2012;57:27-40.</ref><ref>Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. [https://pubmed.ncbi.nlm.nih.gov/17017270/ The intertester reliability of the scapular assistance test.] Journal of Orthopaedic & Sports Physical Therapy. 2006 Sep;36(9):653-60.</ref><ref>Rabin A, Chechik O, Dolkart O, Goldstein Y, Maman E. [https://pubmed.ncbi.nlm.nih.gov/30268967/ A positive scapular assistance test is equally present in various shoulder disorders but more commonly found among patients with scapular dyskinesis.] Physical Therapy in Sport. 2018 Nov 1;34:129-35.</ref>


The SRT is described by Kibler et al <ref>Kibler WB, Sciascia A, Dome D. [https://pubmed.ncbi.nlm.nih.gov/16735587/ Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test.] The American journal of sports medicine. 2006 Oct;34(10):1643-7.</ref> to establish the effect of scapular retraction stabilization on the improvement of supraspinatus strength deficits in patients with SD. <ref>Smith J, Dietrich CT, Kotajarvi BR, Kaufman KR. [https://pubmed.ncbi.nlm.nih.gov/16679235/ The effect of scapular protraction on isometric shoulder rotation strength in normal subjects.] Journal of shoulder and elbow surgery. 2006 May 1;15(3):339-43.</ref> <ref>Khazzam M, Gates ST, Tisano BK, Kukowski N. [https://pubmed.ncbi.nlm.nih.gov/30302349/ Diagnostic accuracy of the scapular retraction test in assessing the status of the rotator cuff.] Orthopaedic Journal of Sports Medicine. 2018 Sep 25;6(10):2325967118799308.</ref> To perform the test, the examiner stabilizes the medial scapular border with one hand, whilst the patient is asked to elevate the arm with 90 degrees of flexion in internal rotation and held the position against the examiner's other hand. The test is positive if the pain felt by the patient is reduced with this manoeuvre or the patient's strength is increased. <ref name=":7" />  
In SRT, the patient is asked to do 90 degrees of flexion with shoulder internal rotation while the examiner stabilizes the medial scapular border with one hand. Then the patient is asked to hold the position while the examiner is applying resistance with the other hand. If the pain felt by the patient is decreased or the strength is increased with the assistance the test is positive. <ref name=":7" /> This test is described by Kibler et al <ref>Kibler WB, Sciascia A, Dome D. [https://pubmed.ncbi.nlm.nih.gov/16735587/ Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test.] The American journal of sports medicine. 2006 Oct;34(10):1643-7.</ref> to establish the scapular retraction stabilization on the improvement of supraspinatus strength deficits in patients with SD. <ref>Smith J, Dietrich CT, Kotajarvi BR, Kaufman KR. [https://pubmed.ncbi.nlm.nih.gov/16679235/ The effect of scapular protraction on isometric shoulder rotation strength in normal subjects.] Journal of shoulder and elbow surgery. 2006 May 1;15(3):339-43.</ref><ref>Khazzam M, Gates ST, Tisano BK, Kukowski N. [https://pubmed.ncbi.nlm.nih.gov/30302349/ Diagnostic accuracy of the scapular retraction test in assessing the status of the rotator cuff.] Orthopaedic Journal of Sports Medicine. 2018 Sep 25;6(10):2325967118799308.</ref>  


==='''Assessment of Surrounding Structures'''===
==='''Assessment of Surrounding Structures'''===

Revision as of 01:52, 28 April 2023

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (14/04/2023)

Introduction[edit | edit source]

Scapular dyskinesia (SD) is a term that describes a physical impairment in which the scapula's position and motion are altered. The words dyskinesia or dysrhythmia are often used instead of dyskinesia. [1][2][3] One of the other terms used for SD is scapular winging, but it is a different condition that results in scapular dyskinesia usually after a long thoracic or spinal accessory nerve injury. [4][5][6]

SD can be seen in overhead athletes or patients with shoulder pathology such as rotator cuff disease, glenohumeral instability, impingement syndrome, and labral tears as well as healthy people. [7] [8]

Scapular Biomechanics[edit | edit source]

© Primal Pictures

The movement of the scapula can be divided into 3 motions and 2 translations.

The motions are:

  1. Upward/downward rotation
  2. Internal/ external rotation
  3. Anterior/posterior tilt

The translations are:

  1. Upward/downward sliding on the thorax
  2. Medial/lateral sliding around the curvature of the thorax


Common patterns of the scapula are called scapular retraction (external rotation, posterior tilt, upward rotation and medial translation), protraction (internal rotation, anterior tilt, downward rotation and lateral translation), and shrug (upward translation, anterior tilt, and internal rotation). [9][10]

During the normal overhead upper extremity elevation with internal/external rotation being minimal until 100°, primary scapular movement is upward rotation and secondary scapular movement is posterior tilt. [11][12]

The coordinated movement between the scapula and humerus which is necessary for efficient arm movement is termed scapulohumeral rhythm. [13] An early study [14] found an overall ratio of 2:1 between glenohumeral elevation and scapular upward rotation. Another study [12] found that during the scapular plane elevation of the arm, there was a consistent pattern of scapular upward rotation, posterior tilting, and external rotation along with clavicular elevation and retraction.

The altered mechanics in SD are increased scapular anterior tilt, increased scapular internal rotation, and altered scapular upward rotation. [15]

Etiology[edit | edit source]

The causes of SD are many, but they can be looked at in these three groups:

  1. Shoulder-related;
  2. Neck-related;
  3. Posture-related. [16]


1. Shoulder-related: Shoulder pathologies associated with SD (acromioclavicular instability, shoulder impingement, rotator cuff injuries, glenoid labrum injuries, clavicle fractures [17][10]), inflexibility of the pectoralis minor and short head of the biceps, and stiffness of the posterior glenohumeral capsule can be counted for this group. [18][19][12]

2. Neck-related: Mechanical neck pain syndromes and cervical nerve root-related syndromes. [16]

3. Posture-related: Excessive thoracic kyphosis and cervical lordosis, which are the changes that athletes are more tend to show are related with SD. [20]

Clinical Presentation[edit | edit source]

Patients with SD can be symptomatic or asymptomatic. [21] Symptoms of SD can be one or a combination of the following: [22]

  • Anterior shoulder pain
  • Posterosuperior scapular pain (may radiate into the ipsilateral para spinous cervical region or radicular/thoracic outlet-type symptoms in the affected upper extremity can be found)
  • Superior shoulder pain
  • Proximal lateral arm pain

Clinical Examination[edit | edit source]

There is no standard clinical assessment of SD. However, some assessment methods have proven to be reliable. [8] [8]

Determining The Presence or Absence of Dyskinesia[edit | edit source]

Based on visual observation, one of the four types can be determined during arm movements in terms of the presence of SD: [23]  [24]

  • Type 1: Inferior angle prominence,
  • Type 2: Medial border prominence,
  • Type 3: Excessive superior border elevation,
  • Type 4: Absence of SD, symmetric scapular motion.

Manually Assisted Movements of Scapula[edit | edit source]

To determine the role of the scapula position in shoulder pain two tests that apply manual assistance to the scapula are The Scapular Assistance Test (SAT) and The Scapular Reposition (Retraction) Test (SRT). [25]

In the SAT, the patient is asked to elevate the arm in sagittal plane and rate the pain on the 11-point numerical pain rating scale. The same process is repeated while the examiner pushes upward and laterally on the inferior angle, and pulls the superior aspect of the scapula (to produce posterior tilt). If two or more points of pain decrease after assisted movement, the test is positive. [26][27][28][29][30]

In SRT, the patient is asked to do 90 degrees of flexion with shoulder internal rotation while the examiner stabilizes the medial scapular border with one hand. Then the patient is asked to hold the position while the examiner is applying resistance with the other hand. If the pain felt by the patient is decreased or the strength is increased with the assistance the test is positive. [31] This test is described by Kibler et al [32] to establish the scapular retraction stabilization on the improvement of supraspinatus strength deficits in patients with SD. [33][34]

Assessment of Surrounding Structures[edit | edit source]

To exclude or confirm alternative causes of the symptoms the examiner should assess the structures around the scapula such as the thoracic spine, the acromioclavicular joint, rotator cuff muscles, the biceps and the glenoid labrum in terms of pain, loss of function, soft tissue laxity and muscle power. [31]

The clavicle should be assessed for angulation, shortening or malrotation. The sternoclavicular (SC) and acromioclavicular (AC) joints should be evaluated for instability. The AC joint can be assessed for anterior-posterior (AP) laxity by stabilizing the clavicle with one hand while grasping and mobilizing the acromion in an AP direction with the other hand. [31][2]

The infraspinatus strength test showed good reliability to assess infraspinatus weakness due to SD. [8]

Muscle Tests[edit | edit source]

Three muscle tests that the clinician observes the scapula position can be defined:

  • Manual resistance of the arm at 130° of flexion (targets the serratus anterior) [35][36]
  • Manual resistance of the arm at 130-150° of abduction (targets the lower and middle trapezius) [35]
  • Extension of the arm at the side (targets the rhomboid) [37]


Scapular muscle weakness can be considered if the break both in the position and scapular movement occur. [3]

Core Evaluation[edit | edit source]

To determine if the hip and core strength facilitate the scapular and shoulder muscle activation the low row test can be performed. ln this test the patient is first asked to do a slight humeral extension and then resist the movement of the arm into flexion. The same anterior force on the arm is applied by the examiner, which stands behind the patient but this time with the instruction to contract the gluteal muscles. The increased strength with the gluteal contraction suggests lower extremity/core strengthening in the treatment plan for the shoulder. [3]

Outcome Measures[edit | edit source]

DASH is a self-report questionnaire, that includes 30 items to measure disability and symptoms of the upper limb for patients with any or multiple musculoskeletal disorders. [38]

Physiotherapy Management[edit | edit source]

Scapular retraction, posterior tilt and external rotation are aimed at the treatment of SD. Specific exercises for scapular rehabilitation are [8]:

Flexibility exercises to reduce scapular traction: Stretching exercises with shoulder horizontal abduction at 90 degrees and 150 degrees of elevation for increasing pectoralis minor flexibility and the external rotation and posterior tilt of the scapula during forward elevation. [39][40][41]

Stabilization exercises based on stretching and strengthening to optimize scapular kinematics, and improve muscle strength and joint position sense [42] [43] [44]: Closed and open kinetic chain exercises, including push-ups, lawnmower exercises, and resisted scapular retraction. [42] [44]


Since research has highlighted that the serratus anterior and trapezius muscles are the muscles that mostly affect scapular movement and cause dyskinesia [16], rehabilitation should consider these muscles that play important role in scapular stabilisation. These muscles act as a force couple by co-contraction or co-activation throughout the shoulder range motion and it is particularly important in the overhead position. [45][46][47]

Push-ups improve the serratus anterior stretch and general muscle strength with Red Cord slings when performed on a stable surface; decrease the activation of the serratus anterior while increasing the activation of the trapezius when performed on an unstable surface. [48][49]

Shrug exercises are a good choice for upper and lower trapezius stimulation and are useful to increase the upward rotation angle and the upper trapezius activity for the patient with SD and corresponding scapular downward rotation syndrome. [50] [51] But, should be avoided in the first 4-6 weeks of rehabilitation to not overly bias the upper trapezius which could delay the restoration of scapular muscle balance. [3]


Kinesio taping method effects are reviewed in an article [8]. It has been concluded that Kinesio taping over the upper and lower trapezius may rebalance the scapular muscles, increasing the upward scapular rotation for type 2 SD. [52]

Presentations[edit | edit source]

http://vimeo.com/14715270Scapula-rehabilitation-presentation.png
 Advanced Exercises for the Upper Quarter: A How To Guide for Scapular Motor Control Rehabilitation

This presentation, created by Stephanie Pascoe as part of the OMPT Fellowship in 2010, describes a how to guide for scapulothoracic rehabilitation. It includes some great animations!

View the presentation

References[edit | edit source]

  1. ↑ Depreli Ö, Angın E. Review of scapular movement disorders among office workers having ergonomic risk. Journal of back and musculoskeletal rehabilitation. 2018 Jan 1;31(2):371-80.
  2. ↑ 2.0 2.1 Kibler BW, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. JAAOS-journal of the American academy of orthopaedic surgeons. 2012 Jun 1;20(6):364-72.
  3. ↑ 3.0 3.1 3.2 3.3 Sciascia A, Kibler WB. Current Views of Scapular Dyskinesis and its Possible Clinical Relevance. International Journal of Sports Physical Therapy. 2022;17(2):117.
  4. ↑ Humphrey CS, Sears BW, Curtin MJ. An anthropometric analysis to derive formulae for calculating the dimensions of anatomically shaped humeral heads. Journal of Shoulder and Elbow Surgery. 2016 Sep 1;25(9):1532-41.
  5. ↑ Kibler WB, Sciascia AD. Disorders of the scapula and their role in shoulder injury. Gewerbestrasse, Switzerland: Springer International Publishing. 2017:128-30.
  6. ↑ Didesch JT, Tang P. Anatomy, etiology, and management of scapular winging. The Journal of hand surgery. 2019 Apr 1;44(4):321-30.
  7. ↑ Teixeira DC, Alves L, Gutierres M. The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge. EFORT Open Reviews. 2021 Oct;6(10):932.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Giuseppe LU, Laura RA, Berton A, Candela V, Massaroni C, Carnevale A, Stelitano G, Schena E, Nazarian A, DeAngelis J, Denaro V. Scapular dyskinesis: from basic science to ultimate treatment. International journal of environmental research and public health. 2020 Apr;17(8):2974.
  9. ↑ Barcia AM, Makovicka JL, Spenciner DB, Chamberlain AM, Jacofsky MC, Gabriel SM, Moroder P, von Rechenberg B, Sengun MZ, Tokish JM, MRAB Study Group. Scapular motion in the presence of rotator cuff tears: a systematic review. Journal of Shoulder and Elbow Surgery. 2021 Jul 1;30(7):1679-92.
  10. ↑ 10.0 10.1 Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. British journal of sports medicine. 2010 Apr 1;44(5):300-5.
  11. ↑ Ludewig PM et al. Motion of the shoulder complex during multiplaner humeral elevation. J Bone Joint Surg. Am.2009;91:378-389.
  12. ↑ 12.0 12.1 12.2 McClure PW et al. Direct 3-dimentional measurement of scapular kinematics during dynamic movements in vivo.J Shoulder Elbow Surg.2001:10:269-277.
  13. ↑ Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. British journal of sports medicine. 2013 Sep 1;47(14):877-85.
  14. ↑ Inman VT, Saunders JD, Abbott LC. Observations on the function of the shoulder joint. JBJS. 1944 Jan 1;26(1):1-30.
  15. ↑ Kibler WB, Stone AV, Zacharias A, Grantham WJ, Sciascia AD. Management of scapular dyskinesis in overhead athletes. Operative Techniques in Sports Medicine. 2021 Mar 1;29(1):150797.
  16. ↑ 16.0 16.1 16.2 Panagiotopoulos AC, Crowther IM. Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT-J. 2019;5.
  17. ↑ Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2003 Apr 1;19(4):404-20.
  18. ↑ Borstad JD. Resting position variables at the shoulder: evidence to support a posture-impairment association. Physical Therapy. 2006 Apr 1;86(4):549-57.
  19. ↑ Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. Journal of orthopaedic & sports physical therapy. 2005 Apr;35(4):227-38.
  20. ↑ Crosbie J, Kilbreath SL, Hollmann L, York S. Scapulohumeral rhythm and associated spinal motion. Clinical biomechanics. 2008 Feb 1;23(2):184-92.
  21. ↑ Pires ED, Camargo PR. Analysis of the kinetic chain in asymptomatic individuals with and without scapular dyskinesis. Clinical Biomechanics. 2018 May 1;54:8-15.
  22. ↑ Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003 Jul 1;19(6):641-61.
  23. ↑ Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy: the journal of arthroscopic & related surgery. 2009 Nov 1;25(11):1240-8.
  24. ↑ Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. Journal of shoulder and elbow surgery. 2002 Nov 1;11(6):550-6.
  25. ↑ Kopkow C, Lange T, Schmitt J, Kasten P. Interrater reliability of the modified scapular assistance test with and without handheld weights. Manual therapy. 2015 Dec 1;20(6):868-74.
  26. ↑ Kibler WB, Sciascia AD. Introduction to the second international conference on scapular dyskinesis in shoulder injury—the ‘Scapular summit’report of 2013. British journal of sports medicine. 2013 Sep 1;47(14):874-.
  27. ↑ Kibler BW, McMullen J. Scapular dyskinesis and its relation to shoulder pain. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2003 Mar 1;11(2):142-51.
  28. ↑ Kibler WB. The scapula in rotator cuff disease. Rotator Cuff Tear. 2012;57:27-40.
  29. ↑ Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the scapular assistance test. Journal of Orthopaedic & Sports Physical Therapy. 2006 Sep;36(9):653-60.
  30. ↑ Rabin A, Chechik O, Dolkart O, Goldstein Y, Maman E. A positive scapular assistance test is equally present in various shoulder disorders but more commonly found among patients with scapular dyskinesis. Physical Therapy in Sport. 2018 Nov 1;34:129-35.
  31. ↑ 31.0 31.1 31.2 Kilber WB, Sciascia A (2010) Current concepts: scapular dyskinesis. British Journal of Sports Medicine. 44, 300–305. [CrossRef] [PubMed] [Google Scholar]
  32. ↑ Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. The American journal of sports medicine. 2006 Oct;34(10):1643-7.
  33. ↑ Smith J, Dietrich CT, Kotajarvi BR, Kaufman KR. The effect of scapular protraction on isometric shoulder rotation strength in normal subjects. Journal of shoulder and elbow surgery. 2006 May 1;15(3):339-43.
  34. ↑ Khazzam M, Gates ST, Tisano BK, Kukowski N. Diagnostic accuracy of the scapular retraction test in assessing the status of the rotator cuff. Orthopaedic Journal of Sports Medicine. 2018 Sep 25;6(10):2325967118799308.
  35. ↑ 35.0 35.1 Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Physical therapy. 2005 Nov 1;85(11):1128-38.
  36. ↑ Ekstrom RA, Soderberg GL, Donatelli RA. Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis. Journal of Electromyography and Kinesiology. 2005 Aug 1;15(4):418-28.
  37. ↑ Ginn KA, Halaki M, Cathers I. Revision of the Shoulder Normalization Tests is required to include rhomboid major and teres major. Journal of Orthopaedic Research. 2011 Dec;29(12):1846-9.
  38. ↑ Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). Journal of orthopaedic & sports physical therapy. 2014 Jan;44(1):30-9.
  39. ↑ Umehara J, Nakamura M, Nishishita S, Tanaka H, Kusano K, Ichihashi N. Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals. Journal of shoulder and elbow surgery. 2018 Jul 1;27(7):1214-20.
  40. ↑ Umehara J, Nakamura M, Fujita K, Kusano K, Nishishita S, Araki K, Tanaka H, Yanase K, Ichihashi N. Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle. Journal of shoulder and elbow surgery. 2017 Jul 1;26(7):1159-65.
  41. ↑ Morais N, Cruz J. The pectoralis minor muscle and shoulder movement-related impairments and pain: Rationale, assessment and management. Physical Therapy in Sport. 2016 Jan 1;17:1-3.
  42. ↑ 42.0 42.1 Struyf F, Nijs J, Meeus M, Roussel NA, Mottram S, Truijen S, Meeusen R. Does scapular positioning predict shoulder pain in recreational overhead athletes?. International journal of sports medicine. 2013 Jul 3:75-82.
  43. ↑ Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. Journal of back and musculoskeletal rehabilitation. 2011 Jan 1;24(3):173-9.
  44. ↑ 44.0 44.1 Turgut E, Duzgun I, Baltaci G. Effects of scapular stabilization exercise training on scapular kinematics, disability, and pain in subacromial impingement: a randomized controlled trial. Archives of physical medicine and rehabilitation. 2017 Oct 1;98(10):1915-23.
  45. ↑ Magee DJ. Orthopedic Physical Assessment-E-Book. Elsevier Health Sciences; 2013 Dec 1.
  46. ↑ BAGG SD, FORREST WJ. Electromyographic study of the scapular rotators during arm abduction in the scapular plane. American Journal of Physical Medicine & Rehabilitation. 1986 Jun 1;65(3):111-24.
  47. ↑ Magarey ME, Jones MA. Dynamic evaluation and early management of altered motor control around the shoulder complex. Manual therapy. 2003 Nov 1;8(4):195-206.
  48. ↑ De Mey, K.; Danneels, L.; Cagnie, B.; Borms, D.; T’Jonck, Z.; Van Damme, E.; Cools, A.M. Shoulder muscle activation levels during four closed kinetic chain exercises with and without Redcord slings. J. Strength Cond. Res. 2014, 28, 1626–1635. [CrossRef]
  49. ↑ Pirauá AL, Pitangui AC, Silva JP, dos Passos MH, de Oliveira VM, Batista LD, de Araújo RC. Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis. Journal of Electromyography and Kinesiology. 2014 Oct 1;24(5):675-81.
  50. ↑ Pizzari T, Wickham J, Balster S, Ganderton C, Watson L. Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula. Clinical biomechanics. 2014 Feb 1;29(2):201-5.
  51. ↑ Lee JH, Cynn HS, Choi WJ, Jeong HJ, Yoon TL. Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Human movement science. 2016 Feb 1;45:119-29.
  52. ↑ Huang TS, Ou HL, Lin JJ. Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis. Journal of Hand Therapy. 2019 Jul 1;32(3):345-52.
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