Healthy Tahoe: Don’t let shoulder dysfunction slow you down

Jeffery Orr, MD

The shoulder blade, also known as the scapula, provides the base for normal shoulder and arm function. Abnormal scapular position and motion is called scapular dyskinesis and can occur when this base doesn’t function properly.

Dr. Jeffrey Orr

The scapula rotates and slides in a coordinated fashion to support the arm. However, it has very limited bony connection, and relies upon its many muscle attachments (17 in total) for stability. Every muscle needs to fire in harmony for the scapula to be balanced and for it to balance the arm. A good example is to think of a marionette puppet with many strings attached. If one or two strings are not tensioned and working properly, the whole puppet won’t move correctly.

There are many causes of scapular dyskinesis, which is defined as the loss of control of normal scapular physiology, mechanics and motion. This can result from an injury, such as a shoulder dislocation or a clavicle fracture. It can also arise from long-term muscle imbalance or poor posture. Certain sports with repetitive overhead movements, such as baseball, volleyball, and swimming, have a high likelihood of leading to scapular dyskinesis as well.

Common symptoms of scapular dyskinesis include pain around the shoulder blade, a feeling that the shoulder blade is out of place, or snapping or a popping sensation with shoulder motion.

Evaluation of the scapula is performed in the clinical setting, with emphasis on scapular positioning and movement. Imaging may not be required for diagnosis, but may be helpful to rule out additional injuries. A nerve study may be required for more advanced cases.

Many scapular concerns can be treated without surgery and rely on improving posture, muscle balance and coordination. Initial treatment for scapular issues may include stretches and exercises performed at home, or at a physical therapy clinic with a trained specialist. A list of exercises to improve shoulder issues can be found at When addressed, symptoms typically improve within three months.

Dr. Jeffrey Orr is a board-certified orthopedic surgeon, specializing in operative and non-operative services for patients’ orthopedic and sports medicine needs. Dr. Orr sees patients in Carson City, Incline Village, and at the Barton Center for Orthopedics & Wellness in South Lake Tahoe, CA. For more information, visit

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