What Is A SICK Scapula?

Scapular Dyskinesis And The SICK Scapula

Scapulohumeral rhythm refers to the coordinated movement that occurs between the scapula and humerus. The coordination of the movement between the shoulder blade socket and the ball of the humerus is necessary with movements of the upper limb and crucial with overhead pushing and pulling activities (such as performing gym exercises like a shoulder press, or pull up) and horizontal pushing and pulling activities (such as performing gym exercises including a push up, or wide row exercise).
A coordinated scapulohumeral rhythm is necessary for full pain free shoulder movements and disruption to this rhythm through scapular dyskinesis (where the prefix “dys” a refers to “abnormal or difficult” and kinesis referring to “motion”) can cause a syndrome referred to as having a SICK scapula.

With regard to the scapula the acronym SICK stands for:
S – Scapula Malposition: meaning poor positioning of the shoulder blade.
I – Inferior Medial Border Prominence: refers to winging of the shoulder blade.
C – Coracoid Pain and Malposition: scapular pain at the front of the shoulder.
K – Kinesis Abnormalities of the Scapula: abnormal shoulder blade movement.

So What Does A SICK Scapula Actually Look Like?

At rest a SICK scapula is often quite easily spotted, where it will be seen to be “drooping” effectively sitting lower with winging of the inside (medial) border of the shoulder blade nearest the spine. Simply put it the shoulder will look lower than the other side and as if you could more easily slide the tips of your fingers under the bottom part of the shoulder blade nearest to the spine. Having a SICK scapula can reduce stability in the glenohumeral joint and reduce an individuals functional strength and the range of movements they have control over. If left untreated a SICK scapula may develop into something more significant than a visual asymmetry with some mild strength or movement variations. In our Randwick and Sydney physio practices it is not uncommon to see a SICK scapula presentation in people coming to our practice with painful conditions like shoulder impingement and rotator cuff injuries.

Potential Causes Of Disruption To Scapula Rhythm

A SICK scapula can be either a precursor to injury, or the result of a previous one. The presence of a SICK scapula is not uncommon in people repetitively performing strenuous above head activities be they in a sporting or work setting. As with most systems and machines all parts must work together perfectly for smooth operation of the machine. With the shoulder, the entirety of the muscles of the shoulder and shoulder blade must work together perfectly for optimal function. Any tightness, weakness or instability any where within the system can lead to impaired function, pain and/or injury.
Repetitive overhead activities like throwing or tennis serves can create this exact situation. Repetitive actions like this can cause certain muscles strength imbalances to develop as well as muscle and soft tissues tightening again to occur in an unbalanced fashion. At risk activities risking the development of the common imbalances seen with a SICK scapula would commonly include individuals, or athletes involved in throwing, swimming or racquet sports as well as weight lifters performing a lot of lifting exercises at and/or above shoulder height.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on What Is A SICK Scapula? should consult his or her general practitioner, sports medicine specialist, physiotherapist or otherwise appropriately skilled practitioner.