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Key muscles involved in scapular stability and movement include:
• Trapezius (upper, middle, and lower fibers)
• Serratus anterior
• Rhomboids (major and minor)
• Levator scapulae
• Pectoralis minor
SICK scapula syndrome often results from a combination of factors:
1. Repetitive overhead activities (e.g., swimming, tennis, baseball)
2. Muscle imbalances or weakness
3. Poor posture
4. Nerve injuries (e.g., long thoracic nerve palsy)
5. Previous shoulder or neck injuries
6. Anatomical variations (e.g., clavicular or acromial abnormalities)
Patients with SICK scapula syndrome typically present with:
• Shoulder pain, often vague and diffuse
• Pain around the medial border of the scapula
• Coracoid process tenderness
• Visible scapular dyskinesis during arm movement
• Decreased shoulder range of motion
• Weakness in shoulder girdle muscles
• Fatigue during overhead activities
• Possible associated conditions (e.g., rotator cuff tendinopathy, labral tears)
1. Observation:
• Scapular positioning at rest and during movement
• Scapular winging or dyskinesis
• Postural abnormalities
2. Palpation:
• Tenderness along the medial scapular border
• Coracoid process pain
• Muscle tone and trigger points
3. Range of motion assessment:
• Active and passive shoulder ROM
• Scapulothoracic motion
4. Strength testing:
• Rotator cuff muscles
• Scapular stabilizers (trapezius, serratus anterior, rhomboids)
5. Special tests:
• Scapular assistance test
• Scapular retraction test
• Lateral scapular slide test
6. Neurological examination:
• Assessment of long thoracic, dorsal scapular, and spinal accessory nerves
Imaging:
While diagnosis is primarily clinical, imaging can be helpful in ruling out other pathologies:
• X-rays: To assess bony abnormalities or fractures
• MRI: Useful for evaluating soft tissue structures and associated injuries
• EMG/NCS: May be indicated if nerve involvement is suspected
Differential Diagnosis:
• Rotator cuff tendinopathy or tears
• Labral injuries
• Cervical radiculopathy
• Thoracic outlet syndrome
• Acromioclavicular joint pathology
• Glenohumeral instability
Management:
Treatment of SICK scapula syndrome is primarily conservative and focuses on addressing the underlying biomechanical issues:
1. Activity modification:
• Temporary reduction or cessation of aggravating activities
• Technique modification in sport-specific movements
2. Physical therapy:
• Scapular stabilization exercises
• Rotator cuff strengthening
• Postural correction
• Flexibility exercises for pectoralis minor and posterior capsule
3. Manual therapy:
• Soft tissue mobilization
• Joint mobilization of the cervical and thoracic spine
4. Pain management:
• NSAIDs for acute pain relief
• Occasional use of corticosteroid injections for recalcitrant cases
5. Addressing associated conditions:
• Treatment of concurrent pathologies (e.g., rotator cuff tendinopathy)
6. Gradual return to sport:
• Sport-specific rehabilitation
• Biomechanical analysis and correction of throwing/overhead mechanics
7. Surgery:
• Rarely indicated
• May be considered for refractory cases or significant associated pathology
Prevention:
Preventing SICK scapula syndrome involves:
• Proper warm-up and cool-down routines
• Balanced strength and flexibility training programs
• Attention to proper technique in overhead activities
• Regular assessment of scapular position and movement in at-risk athletes
• Early intervention when symptoms arise
Prognosis:
With appropriate management, most athletes with SICK scapula syndrome can return to their pre-injury level of performance. However, the recovery process can be lengthy, often taking several months of dedicated rehabilitation. Recurrence is possible, especially if underlying biomechanical issues are not fully addressed.
SICK scapula syndrome is a complex condition that requires a thorough understanding of shoulder biomechanics and a multifaceted approach to management. Sports medicine specialists play a crucial role in early recognition, appropriate treatment, and prevention of this syndrome in overhead athletes. By addressing the underlying biomechanical issues and associated pathologies, most patients can achieve successful outcomes and return to their desired level of activity.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
