Scapular Dyskinesis

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 4 min read
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Scapulothoracic dyskinesis is a rare condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction. Scapular dyskinesis (which may also be referred to as SICK scapula syndrome) is an alteration or deviation in the normal resting or active position of the scapula during shoulder movement....

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

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Article Summary

Scapulothoracic dyskinesis is a rare condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction. Scapular dyskinesis (which may also be referred to as SICK scapula syndrome) is an alteration or deviation in the normal resting or active position of the scapula during shoulder movement. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons....

Key Takeaways

  • This article explains Other Names in simple medical language.
  • This article explains Pathophysiology in simple medical language.
  • This article explains Causes in simple medical language.
  • This article explains Symptom in simple medical language.
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Definition

Scapulothoracic dyskinesis is a rare condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction. Scapular dyskinesis (which may also be referred to as SICK scapula syndrome) is an alteration or deviation in the normal resting or active position of the scapula during shoulder movement. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. For most people, the scapula moves in abnormal ways due to the repetitive use of the shoulder. 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.

Typical scapular dyskinesis symptoms include Weakness in the arm on the affected side – including the arm feeling “dead” or “heavy” Pain and/or tenderness on and around the shoulder blade, particularly on the inner (medial) edge and at the top of the scapula.

Scapular winging involves one or both shoulder blades sticking out from the back rather than lying flat. It can happen as a result of injury or nerve damage. The scapula, or shoulder blades, are flat bones that connect the upper arm to the collar bone. When they come out of place, it can cause scapular winging.

Other Names

  • Scapular Dyskinesia
  • Scapulothoracic Dyskinesis
  • SICK Scapula Syndrome
  • Scapular Malpositioning, Inferior medial border prominence, Coracoid pain and malposition and DysKinesis of scapular movement
  • Scapular Dysfunction

Pathophysiology

  • Role of scapula
    • Provides synchronous scapular rotation during humeral motion
    • Serves as a stable base for Rotator Cuff activation
    • Functions as a link in the kinetic chain
  • Scapular dyskinesis definition[3]
    • 1: Abnormal static scapular position and/or dynamic scapular motion characterized by medial border prominence
    • 2: Inferior angle prominence and/or early scapular elevation or shrugging on arm elevation; and/or
    • 3: Rapid downward rotation during arm lowering

Causes

  • Injuries that predispose you to developing scapular dyskinesis:
    • Acromioclavicular Joint Separation
    • Clavicle Fracture
    • Rotator Cuff Tear
    • Rotator Cuff Tendonitis
    • Calcific Tendinitis of the Rotator Cuff
    • Shoulder Instability
    • Glenoid Labral Tears
    • Poor throwing mechanics
    • Pathologic Kyphosis
    • Neurologic injuries (eg, long thoracic, accessory, or dorsal scapular nerve palsies)
    • Acromioclavicular Joint Pain
    • Winged Scapula
    • Adhesive Capsulitis
  • Primary Stabilizers
    • Levator Scapulae
    • Rhomboid Major, Rhomboid Minor
    • Trapezius
    • Serratus Anterior
  • Secondary Stabilizers
    • Acromioclavicular Joint
    • Glenohumeral Joint
  • Scapulothoracic power imbalance leads to protracted scapula
    • Alteration of shoulder mechanics and can cause secondary injuries
  • Fractures
    • Proximal Humerus Fracture
    • Humeral Shaft Fracture
    • Clavicle Fracture
    • Scapula Fracture
    • First Rib Fracture (traumatic or atraumatic)
  • Dislocations & Seperations
    • Acromioclavicular Joint Separation
    • Glenohumeral Dislocation (Acute)
    • Sternoclavicular Joint Dislocation
    • Glenohumeral Instability (Chronic)
  • Arthropathies
    • Glenohumeral pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">Arthritis
    • Acromioclavicular Joint pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">Arthritis
  • Muscle & Tendon Injuries
    • Pectoralis Major Injuries
    • Pectoralis Minor Injuries
    • Proximal Biceps Tendon Injuries
    • Scapular Dyskinesis
  • Rotator Cuff
    • Rotator Cuff Tear
    • Rotator Cuff Tendonitis
    • Calcific Tendinitis of the Rotator Cuff
    • Subcoracoid Impingement Syndrome
  • Bursopathies
    • Subacromial Bursitis
    • Scapulothoracic Bursitis
  • Ligament Injuries
    • Glenoid Labral Tears
  • Neuropathies
    • Suprascapular Nerve Injury
    • Parsonage-Turner Syndrome
    • Quadrilateral Space Syndrome
    • Winged Scapula
  • Other
    • Adhesive Capsulitis
    • Paget-Schroetter Syndrome
  • Pediatrics
    • Coracoid Avulsion Fracture
    • Humeral Head Epiphysiolysis (Little League Shoulder)

Symptom

Typical scapular dyskinesis symptoms include: Weakness in the arm on the affected side – including the arm feeling “dead” or “heavy” Pain and/or tenderness on and around the shoulder blade, particularly on the inner (medial) edge and at the top of the scapula.

Diagnosis

  • History
    • (Needs to be updated)
  • Physical Exam: Physical Exam Shoulder
    • Scapular exam is done primarily posteriorly with shirt removed (if possible) for complete visualization
    • Important to evaluate resting posture checking for side-to-side asymmetry, especially inferior or medial border prominence
    • Evaluate dynamic scapula position by slow ascent-descent of shoulder 3-5 times
  • Special Tests
    • Scapular Assistance Test: Support the scapula with forwarding flexion of the shoulder
    • Scapular Retraction Test: Retract the scapula manually after a motor exam of the supraspinatus
    • Lateral Scapular Slide Test: measure scapular position with arms in different positions
    • Isometric Pinch Test: “Pinch” scapula together
  • Primarily a clinical diagnosis
  • Standard Radiographs Shoulder and other imaging can be used to identify primary diagnosis

Classification

Kibler Classification

  • Type I or Inferior dysfunction[5]
    • Primary external visual feature is the prominence of the inferior angle
    • Most commonly found in patients with rotator cuff dysfunction.
  • Type 2 or Medial dysfunction
    • Primary external visual feature is the prominence of the entire medial scapular border
    • Medial pattern dysfunction most often occurs in patients with glenohumeral joint instability.
  • Type 3 or Superior dysfunction
    • Characterized by excessive and early elevation of the scapula during upper extremity elevation.
    • Most often seen in patients with rotator cuff dysfunction and deltoid-rotator cuff force couple imbalances

Treatment

Nonoperative

  • First line treatment
  • Primary treatment is directed at the underlying pathology
  • Activity modification
    • Including correcting of throwing mechanics
  • Medications including NSAIDS
  • Physical Therapy
    • Emphasis on core strengthening, scapular stabilizers, rotator cuff, serratus anterior
  • Corticosteroid Injection

Operative

  • Indicated only if primary injury or pathology is considered surgical
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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

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Dermatologist or general physician; emergency care for severe allergic reaction.

What to tell the doctor

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Questions to ask

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Tests to discuss

  • Skin examination
  • Skin scraping/KOH test if fungal infection is suspected
  • Biopsy only for unclear or serious lesions

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  • Avoid unknown mixed creams, especially on face, groin, children, or pregnancy.
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Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Rest, drink safe water, and observe symptoms carefully.
  • Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
  • Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

  • For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
  • Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
  • Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

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Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Scapular Dyskinesis

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

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