The Scapula in Rotator Cuff Disease

The scapula serves as the platform or base for the muscles of the rotator cuff. Rotator cuff function and dysfunction is therefore directly related to the functional state of the scapula. When the scapula is well stabilized, optimal positioning in both static and dynamic tasks allows the rotator cuff to function at an optimal level. However, scapular dysfunction produces an unstable base which in turn negatively affects the rotator cuff's biomechanical contributions to arm motion. Scapular alterations may be causative in rotator cuff dysfunction or may be the result of rotator cuff injury and increase the dysfunction. Possible causative mechanisms such as compromised anatomy (i.e. injury), muscle tightness, and scapular muscle weakness can contribute to the apparent dysfunction. Whether it is a cause or an effect, scapular dyskinesis is frequently identified in rotator cuff disease. Careful examination for presence of scapular dyskinesis and each of the causative mechanisms should be done as part of the comprehensive evaluation of patients with rotator cuff disease. Correction of the alterations following a logically progressed closed to open chain scapular-based program should be included as part of the overall treatment plan.