Where is scapular muscles

Scapular rehabilitation should be part of a broader programme of shoulder physiotherapy to address the functional needs of the individual patient and the concurrent deficiencies of neighbouring structures, such as the shoulder or the neck.

The main goal of therapy is to improve the kinematic chain at different levels from the cervical and thoracic spine to the shoulder. The clinical assessment should identify if scapular dyskinesis is a deficit in soft tissue mobility or muscle action. Deficits in flexibility include different muscle groups and joint components. The mainstay treatment is stretching of the affected structure to increase the working length. The muscles involved are the serratous anterior and the three parts of the trapezius superior, middle, inferior [ 27 ].

The average prescribed duration of such programmes is 12 weeks with satisfactory functional outcomes [ 28 ]. Specific groups that have higher needs such as volleyball players should undergo longer programmes, around 3 months [ 29 ]. The scapular musculature requires re-orientation in order to re-engage the correct pattern of activation.

Research has shown that conscious training of the muscles has definite improvements in the kinematic chain but the results can be reversed [ 31 ].

Further to the rehabilitation of the muscles, the surrounding structures need to be involved. Especially, the resting position of the spine needs to be addressed.

The patient is taught how to maintain a neutral spinal position, respecting the curvatures of the spine at the different levels. This retraining begins from the lumbar spine, followed by the thoracic and finally the cervical spine. The effect is to re-engage the paraspinal stabilizing muscles to maintain a neutral spinal position. It is advised the patients practice this activity multiple times throughout the day [ 32 ].

The main concept of this stage is concurrent activation of muscles in order to perform activities of daily life. The exercises should be repeated under different weight bearing conditions.

Moreover, muscle strength can be achieved by engaging the deficient muscles in isolation whilst minimizing the activity of the stronger ones [ 34 ]. Figure 5 An example of open chain exercise that promotes engagement of the rhomboid and the supraspinatus.

The scapula is an under-appreciated component of the shoulder kinematic chain. The importance is highlighted by the significant improvements in functional ability after rehabilitation. Clinical evaluation of the scapular resting position and function is paramount for the prescription of the necessary physical therapy exercises.

The scapular movement in relation to humeral abduction and the corresponding muscle vectors that affect it. An example of open chain exercise that promotes engagement of the rhomboid and the supraspinatus. Data correspond to usage on the plateform after The current usage metrics is available hours after online publication and is updated daily on week days.

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This condition may be associated with other musculoskeletal defects in the body. The scapula is responsible for several motions which are integral to daily movement and smooth upper extremity motion.

Protraction and retraction of the scapula assist with movement of the pectoral girdle and chest muscles both forward and back, respectively. Elevation and depression of the scapula assist with the movement of the entire shoulder capsule up and down, seen in motions such as shrugging of the shoulders.

Upward rotation and downward rotation of the scapula assist with stabilization of the shoulder capsule during excessive arm motion. Upward rotation of the scapula occurs when the arm moves both up and outward simultaneously. This seemingly simple motion requires significant shoulder stabilization due to the intricacies of the humerus and scapula.

Similar stability is required for downward rotation of the scapula when the arm moves both down and inward simultaneously. The pattern of muscle contractions and motion that occurs between the scapula and the humerus is called the scapulohumeral rhythm, which is a large focus of physical therapy for shoulder pain.

As mentioned, this is often a crucial impairment in those affected by neurological events such as a stroke due to a blockage of nerve and blood supply to this area. An additional mechanism the scapula plays a large role in is the scapulothoracic rhythm, which is the pattern of muscle contractions and motion that occurs between the scapula and the thoracic vertebra.

Similar to the scapulohumeral rhythm, this relationship is vital to the stability of the shoulder joint as a whole.

Due to the strength and location of the scapula bone, fractures are rare and only occur in instances of severe or major multiple trauma.

Ligaments are vital to aid in the maintenance of scapula stability. Injury to the ligaments surrounding the scapula can occur and result in a range of symptoms depending on the severity. This can cause mild pain and loss of range of motion in simple cases or symptoms mimicking that of nerve damage, where there is no motion in the scapula due to loss of ligament function.

Shoulder impingement syndrome is partially caused by impaired scapular movements. This serves to place undue pressure on the nerves and blood supply running through the scapular muscles. When excessive pressure is placed on nerves over an extended period of time, this can lead to a permanent loss of nerve function.

Subluxation is a condition that can occur in any joint in the body. Subluxation of the shoulder joint occurs from extreme forms of ligament laxity. This can be difficult to reverse and, again, early intervention is important to minimize the complications which can result from this condition. Splints and braces are very helpful in promoting proper posture and preventing further injury.

Rest will help lessen the pressure placed on the joint, along with decreasing overall swelling and pain. Rehabilitation of injury to a shoulder ligament injury and shoulder impingement syndrome would include rest and splinting to ensure proper positioning. Proper positioning is important to give the ligament s the opportunity to return to their natural and taut form, if possible.

Positioning is also beneficial to minimize the frequency of the nerve pinching and causing acute, persistent pain. Splints, braces, or slings can be provided by medical professionals or through treatment by a physical or occupational therapist as part of a treatment course. A therapy plan of care would include light exercise, positioning, modalities for pain relief, along with light strengthening exercises once the individual is cleared by their doctor. Subluxation typically occurs as a result of a neurological incident, such as a brain hemorrhage or a stroke.

This causes loss of nerve function to the large nerve network, called the brachial plexus, which lies over the shoulder joint. This means partial or complete loss of motor and sensory function in the impaired arm. In such instances, due to the likelihood of simultaneous cognitive impairment, a treatment method called neuromuscular re-education is a large component of physical and occupational therapy treatments. This type of treatment guides an individual to complete basic strengthening activities and eventually functional activities such as dressing, toileting, bathing, and more using outlined methods in order to assist with reshaping the brain and building motor programs.

Look at the picture of the muscle, find it on your body, and picture how it is contracting as it produces its associated movement or movements. That is, contract the muscle you are reviewing and complete the different actions that the muscle is capable of making.

Mollie is also a boot camp instructor, rugby player, fitness coach and health enthusiast. Mollie moved to San Diego from the Midwest in to pursue her passion of playing rugby and to be able to participate in outdoor fitness year-round. Sign up to receive relevant, science-based health and fitness information and other resources.

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