Scapular Position Symmetry: Does it really Matter?

Physical Therapists often assess and compare scapular kinematics in individuals who present with shoulder pathology.  We do this to develop a reference of movement for the “painful” limb.  But in this practice, have you ever considered if scapular movement is truly “symmetrical” prior to pathology?  A recent article published in Manual Therapy compared the 3-D scapular kinematics of dominant and non-dominant shoulders in “healthy” individuals and the results are quite interesting.
The researchers studied 14 young adults (13 right handed) who volunteered for inclusion.   Each of the participants denied having upper quadrant pain over the past six months nor participated in asymmetric overhead sporting activities on a regular basis.  The researchers utilized electromagnetic tracking to track and register the positioning and orientation of several sensors applied to the upper extremity.   Kinematic data was then taken to assess scapular behavior during shoulder movements.
According to the researchers, this study showed that during rest and with activity (shoulder abduction), scapular positioning differs between dominant and non-dominant arms.  ie. Side-to-side differences likely exist in healthy shoulders.   But this isn’t the only study to demonstrate this—the authors cite several others and claim:

“The observation of asymmetric scapular positioning in this study was not surprising, given that most kinematic investigations demonstrated side-to-side differences in scapular position and motion of healthy populations”.

These findings are quite important to the practicing Therapist.  We often assess symmetry at rest and with movement, but what does it really tell us?   I would love to hear your thoughts….
Morais NV, Pascoal AG. Scapular positioning assessment: Is side-to-side comparison clinically acceptable? Manual Therapy 2013: 18; 46-53

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  • Having had shoulder separation and thoracic nerve damage which caused a winged scapula. Symmetry in the scapula is of major importance in fitness based things like swimming, cycling and running.
    With all of these biomechanics are alter from poor upper body positioning.
    1 – Swimming imbalance in stroke causing excessive pressure on the rotators.
    2 – Cycling poor position on the bike causing pelvic rotation which correlates to lumbar twisting.
    3 – Running poor upper body shoulder rotation causing torque in the back which results in pelvic misalignment.

    Andrew October 7, 2013 3:58 am Reply
    • sorry for the 1 rating down 🙁 was playing with the mouse)

      Bruno Campos October 7, 2013 12:03 pm
  • I’ll leave my 2 cents…
    Looking for assymetry might be important but in a global view. Palpation, pain and ROM, are of much more clinical importance – by the way, the other day I took the time to measure a patient ears and the left was bigger than the right, so assimetry of the ear lobes are not a good indicator- having said that, the scapula is intimately related with the shoulder, as the upper thoracic and the neck, so on avaluating a shoulder, mobility/ pain in those inter-related areas is more reliable for a global diagnosis and treatment. What does scapula assimetry really means in terms of phisiology (and not talking about nerve lesions)? We could speculate shoulder dysfunctions in both cases of hiper and hipomobility, so a single valuable finding doesn’t exist.

    Bruno Campos October 7, 2013 4:59 am Reply
  • It is sensible to look for a pattern rather than rely on one finding.

    June Trenholm October 7, 2013 7:39 am Reply
  • I see the symmetrical positioning of the scapulae as “just one finding” as June noted above, which may or may not be significant to function, which is what really matters in my experience.
    I use a manual therapy approach called Zero Balancing in my private practice, in which we use passive shoulder circumduction to assess the functional mobility of the scapula on the ribcage. To the degree that the “9-12 o’clock” portion of the circumduction movement is limited, the underlying ribs (via costovertebral joint restriction leading to serratus anterior adaptive shortening etc) are restricting scapular mobility and function. This causes compensatory changes in the shoulder joint mechanics which in my experience is the root of many shoulder joint pathologies, not to mention cervical compensatory changes and headaches.

    Jim Lundeen October 7, 2013 11:43 am Reply
  • Ah phew! Looks like my asymmetrical shoulders may not be doing me in after all!
    I really do hope my ears are around the same size though …

    Shane October 7, 2013 11:54 am Reply
    • 🙂 It may sound ridiculous but i find that many look for ear lobe assimetry, that immediatly suggests a lateral flexion of the cervical, even if it’s suggested in a very subtle way…

      osteopatiap October 7, 2013 12:09 pm
  • I am just a second year physiotherapist student, but I’d anyhow like to share my thoughts on the subject.
    As earilier stated, asymmetry of the scapula-thoracic rythm is a finding that could or could not support one’s hypothesis. A assymetric scapula movement becomes important when there is compensation of any kind (muscular or in adjecent joints), possibly caused by hypomobility.
    If one suspects pain in the cervical level or higher to be related to poor or limited scapula-thoarcic motion a AROM and PROM test of shoulder abduction and/or anteversion would be interesting to perform as this could show possible overcompensatory rotation in the cervical spine towards end-range of motion.
    All in all, I would with my current level of knowledge support doing active and passive scaption as a deductive approach to hypothesis-testing when you are suspicious that the complaints may relate to the scapula somehow.

    Benjamin Gullanger October 7, 2013 12:09 pm Reply
  • I think scapular position is another example of being stuck in the pure biomechanical model of treating, searching for things that are “wrong” and trying to “fix them” in order to help the patient’s pain. Reliability for assessing scapular position has been found to be poor (, so maybe coupled with this post PT’s will start to work away from it..hopefully

    Mark October 7, 2013 12:53 pm Reply
  • Reblogged this on Αναγνωστόπουλος Δημήτρης and commented:
    Ένα εξαιρετικό άρθρο για την αξιολόγηση της ωμικής ζώνης από όρθια στάση. Πρόκειται για μία πολύ συνηθισμένη εξέταση για την θέση των ωμοπλατών, την οποία πραγματοποιούμε στην φυσικοθεραπεία, όταν ο ασθενής έχει προβλήματα με τους ώμους του. Πόση όμως πραγματική αξία έχει η συγκεκριμένη εξέταση; (Άρθρο στα αγγλικά).

    Dimitris Anagnostopoulos October 8, 2013 7:14 am Reply
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