Shoulder Blade: Signs, Symptoms, and Causes of Scapular Dysfunction

How Do You Know If Your Shoulder Blade Is Out Of Place?

While the shoulder blade (scapula) itself doesn't typically "go out of place" in the way a joint dislocates, its position and movement can become dysfunctional or "malpositioned" relative to the rib cage, leading to pain and impaired function. Identifying such dysfunction involves a combination of observing visible signs, assessing movement patterns, and recognizing specific symptoms.

Understanding the Shoulder Blade (Scapula)

The scapula is a flat, triangular bone that lies over the posterior aspect of the rib cage. Unlike other bones that articulate directly with the skeleton via a ball-and-socket joint, the scapula forms a unique scapulothoracic joint – a muscular articulation with the thoracic wall. Its stability and movement are entirely dependent on the coordinated action of 17 different muscles that attach to it.

When people ask if their shoulder blade is "out of place," they are often referring to:

• Scapular Dyskinesis: An alteration in the normal position or motion of the scapula during shoulder movements.
• Scapular Malposition: A static resting position of the scapula that deviates from optimal alignment.
• Muscle Imbalances: Weakness or tightness in the muscles that control scapular movement and stability.

These conditions can lead to a feeling that the shoulder blade isn't sitting right or is moving improperly, rather than a true dislocation of the bone itself.

Common Signs and Symptoms of Scapular Dysfunction

Identifying scapular dysfunction often involves a combination of subjective symptoms and objective observations.

• Pain:
  • Location: Often felt in or around the shoulder blade, top of the shoulder, neck, or even radiating down the arm.
  • Type: Aching, burning, sharp, or dull pain, often exacerbated by specific movements or prolonged postures.
• Visible Changes:
  • Asymmetry: One shoulder blade appearing higher, lower, more protracted (forward), or more retracted (backward) than the other at rest.
  • Prominence: The medial border or inferior angle of the scapula sticking out, particularly during arm movements (known as scapular winging).
  • Shoulder Height: One shoulder appearing visibly lower or higher than the other.
• Movement Limitations and Alterations:
  • Reduced Range of Motion: Difficulty raising the arm overhead, reaching behind the back, or performing other shoulder movements.
  • Clicking or Popping: Sounds during shoulder or arm movements, sometimes accompanied by discomfort.
  • Compensatory Movements: The body using other muscles or joints (e.g., shrugging the shoulder excessively) to complete a movement due to scapular instability.
  • Weakness: Perceived or actual weakness in shoulder and arm movements.
• Sensory Changes:
  • Numbness or Tingling: Less common, but can occur if nerve impingement is related to severe muscle tension or altered posture.
  • Stiffness: A feeling of tightness or restricted movement around the shoulder blade and neck.

Visual Assessment: What to Look For

Observing your own posture and movement, or having someone else observe you, can provide significant clues.

• Static Posture (At Rest):
  • Stand relaxed with arms at your sides.
  • Observe from behind: Does one shoulder blade sit higher or lower? Is one closer or further from the spine? Does one angle look different?
  • Observe from the side: Is your upper back rounded (thoracic kyphosis) or are your shoulders excessively rounded forward? These can affect scapular position.
• Dynamic Movement (During Activity):
  • Overhead Arm Raise: Slowly raise both arms out to the sides and overhead, then slowly lower them.
    • Scapular Winging: Does the inside border or bottom tip of either shoulder blade lift away from the rib cage significantly, especially as you raise your arms? This is a primary sign of weakness in muscles like the serratus anterior.
    • Shrugging: Do you excessively shrug your shoulders towards your ears when raising your arms? This can indicate overactivity of upper trapezius muscles compensating for weaker lower stabilizers.
    • Asymmetrical Movement: Does one scapula move more smoothly or differently than the other?

Self-Assessment Tests

While not definitive, these simple tests can highlight potential issues. Always consult a healthcare professional for a proper diagnosis.

• Wall Push-Up Test:
  1. Stand facing a wall, about arm's length away.
  2. Place your hands on the wall, shoulder-width apart, at chest height.
  3. Slowly lean towards the wall, bending your elbows as if doing a push-up against the wall.
  4. Observe your shoulder blades: Does either shoulder blade protrude or "wing out" excessively from your back as you lean in? Significant winging suggests weakness in the serratus anterior muscle.
• Overhead Arm Raise Against Resistance (Light):
  1. Hold a very light weight (e.g., 1-2 lbs) or no weight in each hand.
  2. Slowly raise your arms straight out in front of you and then overhead.
  3. Pay attention to the movement quality: Do you feel a "catch," pain, or notice any jerky movements in your shoulder or scapula? Does one arm feel significantly harder to lift or control?

Underlying Causes of Scapular Dysfunction

Scapular dysfunction is rarely an isolated issue; it's often a symptom of broader musculoskeletal imbalances or conditions. Common causes include:

• Muscle Imbalances:
  • Weakness: Often in the serratus anterior, lower trapezius, and rhomboids.
  • Tightness/Overactivity: Commonly in the pectoralis minor, levator scapulae, and upper trapezius.
• Poor Posture: Chronic slouched or rounded-shoulder postures can stretch and weaken scapular stabilizers.
• Injury or Trauma: Direct impact to the shoulder or nerve damage affecting scapular muscles.
• Nerve Impingement: Conditions like long thoracic nerve palsy can cause severe serratus anterior weakness and prominent winging.
• Repetitive Movements: Activities involving overhead reaching or throwing can lead to overuse injuries and imbalances.
• Joint Issues: Problems with the glenohumeral (shoulder) joint or acromioclavicular (AC) joint can alter scapular mechanics.

When to Seek Professional Help

If you suspect scapular dysfunction, especially if you experience persistent pain, significant weakness, or limited function, it's crucial to consult a healthcare professional. This could be a:

• Physical Therapist (Physiotherapist): Highly skilled in assessing movement patterns, diagnosing musculoskeletal imbalances, and prescribing corrective exercises.
• Orthopedic Doctor: For diagnosis of more serious injuries or conditions requiring medical intervention.
• Sports Medicine Physician: Specializes in activity-related injuries and performance optimization.

Early diagnosis and intervention can prevent further complications, reduce pain, and restore optimal shoulder function. A professional can provide a precise diagnosis and develop a tailored rehabilitation plan.