Scientific/Clinical Article| Volume 30, ISSUE 2, P136-146, April 2017

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Scapular muscle dysfunction associated with subacromial pain syndrome


      Study Design

      Narrative Review.


      One of the shoulder pain disorders in which the function of the scapula is comprised is the subacromial pain syndrome. Several rehabilitation guidelines and exercises have been proposed to improve scapulothoracic muscle dysfunction. Consideration of muscle activation patterns may help to select the most appropriate rehabilitation exercise in these patients. To date, suggesting rehabilitation exercises is often based upon the knowledge of the superficial lying scapulothoracic muscles’ activity. In the assumption that the deeper lying scapulothoracic muscles’ activity may hinder normal scapular movement in case of tightness or hyperactivity, exercise protocols for patients with altered pattern in scapulothoracic muscles should also integrate knowledge on the deeper lying scapulothoracic muscle activity.

      Purpose of the Study

      To help clinicians choosing the most appropriate exercise in patients with subacromial pain syndrome related to scapulothoracic muscle dysfunction.


      First, a summary of key alterations in scapulothoracic (muscle) function in patients with subacromial pain was accomplished. Second, promising practical rehabilitation strategies toward restoring scapulothoracic muscle dysfunction (with a focus on scapulothoracic exercises) were developed, integrating current new research evidence (including information about the deeper lying scapulothoracic muscles) with clinical practice.


      This review details clinical exercises and their muscular activity to guide clinicians to optimize individualized scapulothoracic training and treatment programs by selecting the most appropriate exercise, based on knowledge from the clinical examination.

      Level of Evidence

      Level 5.


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      JHT Read for Credit

      Quiz: #478

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        The authors advocate giving more attention to the ________________ than currently seen in most clinics
        • a.
          posterior portion of the rotator cuff
        • b.
          anterior portion of the rotator cuff
        • c.
          deeper lying scapulothoracic musculature
        • d.
          more superficial scapulothoracic musculature
      • #2.
        A component of normal elevation of the shoulder is
        • a.
          posterior tilt of the scapula
        • b.
          anterior tilt of the scapula
        • c.
          gapping between the scapula and the thoracic cage
        • d.
          gapping between the glenoid and the humeral head
      • #3.
        It can correctly be said that
        • a.
          the scapula is a bridge between the spine and the shoulder
        • b.
          there are limited ligamentous connections between the spine and the scapula
        • c.
          the scapula articulates with both the proximal humerus and the lateral aspect of the clavicle
        • d.
          all of the above
      • #4.
        The article draws attention to the relationship of _____________in the performance of complex functional motions
        • a.
          muscle strength and velocity
        • b.
          muscle strength and peak forces
        • c.
          peak forces and velocity
        • d.
          fatigue and power
      • #5.
        The authors suggest that one major cause of subacromial pain is scapulothoracic motor dysfunction
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.