Following our exploration of the pathomechanics of scapular dyskinesis, this guide provides a step-by-step approach to clinically assessing altered scapular motion. A precise and systematic assessment is the critical first step for any manual therapist—including remedial massage, myotherapists, and Bowen therapists—to identify the underlying mechanical fault rather than simply treating the resultant pain.

 This is Part 2 of our Scapular Dyskinesis series

• Part 1 Scapular Dyskinesis: A Clinical Exploration for Manual Therapists

• Part 3 Scapular Dyskinesis: Treatment Strategies for Manual Therapists

The Static Assessment: Observation at Rest

Begin your assessment by observing the client in a resting position (seated or standing). Look for subtle signs of asymmetry or improper resting posture, which can indicate dominant muscular patterns or chronic inhibition.

• Scapular Position: Note the resting height and distance from the spine. Look for any vertical (one side higher) or horizontal (one side further from the spine) differences.

• Inferior Angle Prominence: Is the bottom tip of the scapula lifting off the rib cage? This is often referred to as tipping and frequently suggests tightness in the Pectoralis Minor muscle.

• Medial Border Prominence: Is the inner edge of the scapula lifting away from the thoracic wall? This is known as winging and is a classic indicator of weakness or inhibition of the Serratus Anterior muscle.

• Shoulder Angle: Observe the position of the acromion. Does one shoulder appear more forward (protracted) or rounded than the other?

Dynamic Assessment: Scapulohumeral Rhythm

The most crucial part of the assessment is observing the scapula during movement, as its role is primarily dynamic. The Scapular Dyskinesis Test is a simple yet powerful tool.

1. Instruction: Ask the client to slowly perform 5-10 repetitions of full arm flexion (raising the arm forward) and arm abduction (raising the arm out to the side). Ensure the movement is slow and deliberate.

2. Observation: Focus your attention entirely on the movement of the scapula, not the shoulder joint itself.

   • "Hitching" or Jerky Movement: Look for an absence of smooth, rhythmic motion, which indicates poor motor control and muscular incoordination.

   • Premature Elevation: The scapula may start moving too early in the arc of motion, relying too heavily on the Upper Trapezius to initiate the movement.

   • Excessive Motion: Look for exaggerated winging or tipping that becomes more apparent as the client reaches the mid-to-end range of the movement.

3. Repetitive Fatigue Test: If the dyskinesis is subtle, have the client perform the movements holding a very light weight (e.g., a water bottle). Fatigue will often amplify the underlying dysfunction.

Manual Assessment: Identify Contributing Factors

Following visual assessment, use your manual skills to confirm the contributing soft tissue restrictions.

• Pectoralis Minor Length: Assess the length of the Pec Minor. A restricted Pec Minor pulls the scapula into an undesirable anterior tilt, making proper upward rotation during movement impossible.

• Thoracic Spine Mobility: Assess the mobility of the thoracic spine. Restricted thoracic extension and rotation often forces the scapula to compensate, as the spine cannot provide the necessary base for overhead motion. Limited mobility in this area is a common kinetic chain fault. This concept of regional interdependence is a key principle in advanced manual therapy.

• Palpation of Stabilizers: Gently palpate the Serratus Anterior and Lower Trapezius for signs of hypotonicity (soft and inactive) or poor quality tissue, confirming the visual assessment of weakness.

Accurate assessment provides the clear direction needed for targeted treatment, saving you and your client time and leading to more predictable, positive outcomes.