Evaluation and management of scapular dysfunction.

The scapula plays an important role in shoulder function and requires both significant mobility and stability. Normal motion is 3-dimensional, and during arm elevation consists of upward rotation, posterior tilting, and external rotation as well as clavicular elevation and retraction. Examination should include visual observation, symptom alterations tests, testing of muscle strength, and flexibility of key structures including the pectoralis minor, posterior shoulder and thoracic spine. Treatment consists of graded resistive exercise, neuromuscular retraining, stretching, manual therapy, and taping where necessary. Although several studies suggest a relationship between abnormal scapular motion and symptoms, strong evidence directly supporting a causal relationship is lacking and further work is necessary to clarify this relationship.