PicoBlog

The scapula sits on the rib cage and forms the base from which the rest of the arm can move. It is not firmly attached to the rib cage like you would think of with other joints. Typically, one bone is connected to another bone through a joint that has ligaments, joint capsules and thick connective tissue to connect the bones, but only muscles hold our scapula onto our rib cage! The scapula has a lot of freedom of movement. It elevates upward, depresses downward, retracts toward our spine, protracts around the rib cage, upwardly rotates and downwardly rotates. All of these motions help with the movement of the rest of the arm. The socket of the shoulder joint is very shallow which allows for this freedom of arm movement as well.

There are a lot of medical issues that can contribute to pain or limited movement in or around the area of the shoulder blade. Some of these problems can include the following:

• rotator cuff tendinitis, tendinopathy, tendinosis, or tear

• scoliosis

• poor rib cage mobility or broken ribs that are healing or have healed

• frozen shoulder aka adhesive capsulitis

• arthritis (osteo or rheumatoid)

• bursitis (inflammation in a fluid-filled sac that helps reduce friction between muscles and bones)

• nerve dysfunction (pinched nerve, nerve injury, medical issues that can disrupt the transmission of nerve impulses). This can be identified with an EMG study.

• menopause and hormonal changes that impact inflammatory responses in the body

With all of these things that can impact your mobility and how your shoulder blade moves, it can be hard to figure out what might be causing problems! So, I’m going to give you some tips, but please know this is not to be taken as medical advice-if you do not know why you have pain, weakness or stiffness, please seek medical attention from a trusted provider.

First, I will ask you to bring awareness to your shoulder blades. Looking at a mirror, notice how your arms rest along your body. Look at which way your palm is facing. Notice if one shoulder looks higher than the other. What about the pelvis? Is it level? Go lower and look at the knees and feet. Are the arches flat? Do the knees turn inward? Take notes of what you see.

For the next observation, you may need help. Have someone either photograph or video you from each side and from the back. Again, observe the feet, knees, hips, pelvis, spine, shoulder blades, shoulders and head. If you take a photo and can print it, take a straight edge and draw a line through the middle of your ear down through your foot when looking at the side view. Notice where the shoulders, the hands, the hips and the feet are in relation to the line.

Looking at yourself from behind, notice what the shoulder blades are doing. They should be fairly level, and they should be resting against the rib cage. Sometimes, you may notice that they look like they stick out away from the rib cage. Instead of sitting close to the rib cage, they stick out. We sometimes refer to that as scapular winging. Look at what part of the scapula is winging out.

• If the border of the scapula that lines up with the spine wings out, that can indicate weakness in the serratus anterior muscles.

• If the bottom angle of the scapula wings out and rotates closer to the spine, then the serratus anterior muscle may be weak.

• The rhomboid major and minor and the upper traps also play a role in this as well. If there is weakness in the upper traps and/or rhomboids, the scapula may wing away from the rib cage meaning the bottom angle rotates away from the spine.

• If there is instability in the posterior aspect of the shoulder joint, scapular winging can occur

Observe your posture in sitting and standing and notice similarities and differences between each side and in each position. If your scapula does wing out, it doesn’t necessarily mean anything is “wrong,” but in the presence of pain or difficulty reaching up or out with the arm, it can be a clue as to what may be contributing to your particular issue.

Take good care,

Sharon

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