The incidence of shoulder pain due to scapular involvement has been reported between 0.9% - 2.5% and the prevalence reported by various studies vary from 6.9-26 % in india.
We use the term SICK to refer to findings one sees in this syndrome -
Scapular malposition
Inferior medial border prominence
Coracoid pain and malposition
Dyskinesis of scapular movement
The hallmark feature of the syndrome is asymmetry and malposition of the scapula , affected scapular side shoulder is lower than other.
In the sick scapula the scapula is protracted and is in anterior tilted position , depressed and lateral shift.

Causes of SICK Scapula include -
weakness of the rhomboid
Imbalance between the scapular muscles
Injury to the nerves that supply muscles
Injury within the shoulder joint
Tigtness of the pectoralis minor - the main cause of pain in coracoid process and shoulder anterior tilt .


scapular dyskinesia  - " altered scapular resting position  and dynamic scapular position " ( Kibler and Sciascia , 2010). According to kibler scapular dyskinesia are three types -
         Type 1. Inferior -medial scapular border prominence
         Type 2. Medial border prominence
         Type 3. Supero- medial border prominence
Signs and Symptoms
Affected  shoulder appears dropped or lower then unaffected shoulder.
medial scapular protrusion.
scapular pain.
Hitches and jumps in scapular motion when arm move.
Noticeable protrusion or " winging" of the scapula.
Diagnosis procedure
clinical observation of scapular dyskinesis- type 1, 2 or 3.
 Manual muscle testing -lower tapezius , and serratus anterior.
check for pectoralis muscle tightness.
symptom altering test - scapular assistance test and lateral scapular slide test .
Management / Interventions
Physical therapy Intervention is aimed at reducing posterior capsule and pectoral minor restriction , maintain strength of middle trapezius , serratus anterior  and minimise the use of upper trapezius. manual stretching to reduce pec. minor tension (150 degree elevation with 30 degree scapular retraction).
Quadruped and variable push - up position to activate serratus anterior , wall ball scours is an another method to maintain strength of scapular muscle. Manual grade 4 mobilization to reduce posterior capsule tension  and you can give cross body stretch also.
PG student
MPT ( neuro)


SICK SCAPULA - IS YOUR SCAPULA IS SICK ! SICK SCAPULA - IS YOUR SCAPULA IS SICK ! Reviewed by The Scripten on May 03, 2020 Rating: 5

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