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24 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 24 Upper trapezius, rhomboids, and serratus anterior. Image courtesy of Complete Anatomy. 1 KEY POINT • Identifying the variations of scapular dyskinesis can lead to the right treatment for shoulder impairment or pain. CLINICAL EXPLORATIONS By Whitney Lowe What Is Scapular Dyskinesis? Understanding This Shoulder Issue Can Lead to Better Client Care Shoulder disorders are diverse and a primary reason why clients might seek soft-tissue therapy. Movement at the shoulder is complex, so when this movement is impaired, it can cause clients signifi cant pain. One such condition is scapular dyskinesis or dyskinesia (SD), which is essentially the faulty movement and position of the scapula. There are several causes of this movement dysfunction. Let's look at the anatomy and function of the shoulder and how intricate movement patterns are related to pain complaints in the shoulder region. ANATOMICAL AND BIOMECHANICAL REVIEW Several shoulder structures play a role in SD. First are the three major bones of the shoulder complex: the scapula, humerus, and clavicle. The ribs are also involved in shoulder movement, but their role is indirect in this condition because they have little movement. However, they anchor the serratus anterior muscle, which we will explore below. Close to 20 muscles are attached to the scapula, so the muscle can get pulled simultaneously from multiple directions. Of these numerous muscles, the most important concerning SD are the upper trapezius, rhomboids, and serratus anterior (Image 1). They produce the most significant forces for upward scapular rotation. We'll see more about how they work together in the biomechanics section. The glenohumeral joint capsule is critically important in guiding and limiting movement at the glenohumeral joint. Restrictions or adhesions in the joint capsule can significantly impact scapular mechanics and often contribute to SD. Other internal injuries can also Rhomboids Upper trapezius Serratus anterior TECHNIQUE