This 2003 narrative review by Kibler and McMullen defines scapular dyskinesis, classifies its patterns, and explains its mechanisms across rotator cuff, labral, and instability diagnoses. It provides a structured examination framework and a proximal-to-distal rehabilitation protocol. The central question: how does altered scapular motion contribute to shoulder pain and dysfunction?
A patient with shoulder impingement or instability who also has a scapular hitch on arm lowering is not just demonstrating a compensatory quirk — the scapular dysfunction is mechanically contributing to their symptoms.
When you see asymmetric medial border prominence, perform the scapular assistance test and scapular retraction test. If either eliminates impingement pain or improves rotator cuff strength on manual testing, serratus anterior and lower trapezius deficits are the primary driver and must be addressed before isolated cuff work will be effective.
Do not jump straight to rotator cuff strengthening. This paper is the foundation for why we use a proximal-to-distal protocol: trunk and hip first, then scapular control, then arm exercises.
The ~5% nerve palsy statistic matters in the workup: if winging is present, the vast majority do not need EMG or nerve studies. Muscle inhibition from pain is the dominant mechanism, and it is reversible with the right rehabilitation sequence.
This 2003 narrative review by Kibler and McMullen defines scapular dyskinesis, classifies its patterns, and explains its mechanisms across rotator cuff, labral, and instability diagnoses. It provides a structured examination framework and a proximal-to-distal rehabilitation protocol. The central question: how does altered scapular motion contribute to shoulder pain and dysfunction?
A patient with shoulder impingement or instability who also has a scapular hitch on arm lowering is not just demonstrating a compensatory quirk — the scapular dysfunction is mechanically contributing to their symptoms.
When you see asymmetric medial border prominence, perform the scapular assistance test and scapular retraction test. If either eliminates impingement pain or improves rotator cuff strength on manual testing, serratus anterior and lower trapezius deficits are the primary driver and must be addressed before isolated cuff work will be effective.
Do not jump straight to rotator cuff strengthening. This paper is the foundation for why we use a proximal-to-distal protocol: trunk and hip first, then scapular control, then arm exercises.
The ~5% nerve palsy statistic matters in the workup: if winging is present, the vast majority do not need EMG or nerve studies. Muscle inhibition from pain is the dominant mechanism, and it is reversible with the right rehabilitation sequence.