Scapular dyskinesis guidelines

Abnormal movement of the shoulder blade (scapula) is known as scapular dyskinesis. This occurs in a variety of shoulder problems. It is an important sign of an underlying shoulder disorder and a guide to shoulder rehabilitation.

Based on PhysioPedia, intervention is aimed at reducing posterior capsule and pectoralis minor restriction and restoring periscapular mm balance through exercises promoting early and increased serratus anterior, lower, and middle trapezius activation while minimizing upper trapezius activity.

• Manual gr 4 mobilization to reduce posterior capsule tension, cross-body stretch.
• Manual stretching and soft tissue mobilization to decrease pec minor tension (cadaveric studies imply that a position of 150 degrees elevation with 30 degrees scapular retraction is optimal).
• Exercises of sidelying forward flexion, external rotation, prone extension, and prone horizontal abduction to strengthen middle and lower trapezius over upper trapezius.
• Quadruped and variable push-up positions to activate serratus anterior.

Here is a very nice guideline for treating scapular dyskinesis, offered by the Beth Israel Deaconess Center (a Harvard Medical School teaching hospital).