Elevation of the Scapula is one of several movements available to the Scapulothoracic Joint that involves superior gliding of the Scapula with a compliment of Sternoclavicular Joint and Acromioclavicular Joint rotations. In layman’s terms this movement describes the raising or “ Shrug ging” of the Scapula relative to the Thorax . This motion performed against resistance also forms a basis for evaluating Cranial Nerve XI or the C4 Myotomes .
Prime Movers
Upper Trapezius
Accessory
Stabilisers
Posterior Sling - may restrict elevation
Spiral Line - may restrict elevation
Superficial Front Arm Line - may restrict elevation
Deep Front Arm Line - may restrict elevation
Superficial Back Arm Line - contraction of Trapezius may be Pain ful
Deep Back Arm Line - contraction pf Levator Scapulae or Rhomboids may be Pain ful
Elevation at the Scapulothoracic Joint occurs as the Scapula glides superiorly, guided by the fixed path of the Clavicle at the Sternoclavicular Joint where it rolls superiorly about an anteroposterior axis while gliding inferiorly on the joints articular disc (SOURCE-2). At the opposing (lateral) end of the Clavicle , the Acromioclavicular Joint makes subtle downward rotational adjustments which allows the Scapula to remain vertical throughout Elevation (SOURCE-7). These understated movements at the other joints allow the Scapula to remain flush with the Thorax (SOURCE-7). A resting posture of slight Elevation and Scapulothoracic Joint - Retraction is considered an optimal position for The Shoulder Girdle as it leaves the Glenoid Fossa facing slightly upwards (SOURCE-7).
Motion is facilitated primarily by the Trapezius which contracts on the lateral Clavicle , Acromion and Spine of Scapula to draw them superiorly (SOURCE-2+6+7). Contribution from the Levator Scapulae aids in lifting the Scapula and offsets some of the upwards rotation bias produced by the Trapezius (SOURCE-2). To a lesser extent, the Rhomboids also elevate the Scapula and play a more significant role in the maintenance of its stability throughout movement (SOURCE-6+7).
Both prime movers have the capacity to compensate for one and other in the presence of insufficiency (SOURCE-3). However, given the Scapulothoracic Joint - Upward Rotation bias of the Upper Trapezius and Scapulothoracic Joint - Downward Rotation bias of the Levator Scapulae , compensation often results in a failure to neutralise these rotations during arm elevation (SOURCE-2).
Like many shoulder movements, Elevation of the Scapula may be subject to Posterior Glenohumeral Joint Capsule tightness may restrict movement and predispose Subacromial Impingement during arm elevation (SOURCE-6). Similarly, hypertonicity of the Subclavius or restriction in the Costoclavicular Ligament or Sternoclavicular Joint Capsule have the capacity to restrict the necessary superior roll/inferior glide of the Clavicle at the Sternoclavicular Joint which may limit the available Elevation range (SOURCE-2).
Premature or excessive Elevation suggests a loss of Scapula stabilisers such as the Serratus Anterior and/or restriction of the Glenohumeral Joint (SOURCE-1+6). This causes the axis of rotation for the Glenohumeral Joint to migrate superiorly which may predispose Subacromial Impingement (SOURCE-12). Excessive Elevation is also associated with mouth- Breathing in children (SOURCE-1).
As the Trapezius plays an integral role in the maintenance of an upwards facing Glenoid Fossa posture, insufficiency and a consequent reduction in Elevation may have wide-spread implications for The Shoulder Girdle at rest and through movement (SOURCE-7). While injury may be caused to the Trapezius through blunt trauma, like those described in more severe forms of Acromioclavicular Joint Dislocation , insufficiency is most often attributed iatrogenic injury to Cranial Nerve XI from surgical procedures that involve thePosterior Cervical Triangle(SOURCE-13+14).
As detailed underPathomechanics, distubance to the intricate balance between each Scapula Elevator and the related stabilisers may be attributed to several causes and predispose several pathologies of The Shoulder Girdle .
Scapular Dyskinesis - both an increase and decrease in Scapula Elevation are considered Dyskinetic patterns. Increased Elevation of the Scapula is a common compensatory response to Glenohumeral Joint restriction which may result from many pathological states including Adhesive Capsulitis , Subacromial Impingement and Pain avoidance/ movement apprehension. Ironically, both increased and decreased Elevation of the Scapula are considered notable predisposing factors for Subacromial Impingement , though through diverging mechanisms (SOURCE-4+6+12).
Cranial Nerve XI Palsy - the most common cause of Upper Trapezius insufficiency may result from blunt trauma, such as those described in more severe forms of Acromioclavicular Joint Dislocation , or more commonly represent a complication of surgical procedures that involve thePosterior Cervical Triangle(SOURCE-13+14).
Thoracic Spine Kyphosis - an excessive Thoracic - Flexion posture is associated with a significant loss of Scapulothoracic Elevation (SOURCE-4).
Excessive Elevation of the Scapula - may suggest:
Glenohumeral Joint restriction
Loss of Scapula Stabilisers (such as Serratus Anterior )
Excessive Scapulothoracic Joint - Depression - may indicate (SOURCE-8+9+10):
Hypertonicity in Pectoralis Minor or Latissimus Dorsi
Upper Trapezius Dysfunction - often of neurogenic cause
Elevation of the Scapula is rarely assessed in isolation and more often evaluated as a composite motion of The Shoulder Girdle or determined by the resting position of the Scapula . With that said, approximately 35-40º of active Elevation should be available to the Scapulothoracic Joint (SOURCE-11). While this movement is often evaluated seated with arms in slight GH Joint - Abduction and 90º Elbow - Flexion , it may also be performed in prone to diminish the effects of gravity (SOURCE-5). In terms of Isometric Tests , active-resisted Elevation also doubles as the motor assessment for Cranial Nerve XI and the C4 Nerve Root .
The following tests may be conducted to rule in/out nerve contribution with C5 , C6 , C7 , C8 and T1 Nerve Roots mst relevant to Scapulothoracic Joint Depression: Cervical - Myotomes (active resisted)
Scapulothoracic Elevation ( Shrug ) - Cranial Nerve XI and C4
Scapulothoracic Joint - Retraction - C5 and Dorsal Scapular Nerve
Cervical - Dermatomes - evaluates sensory region
C3 - skin over the posterior neck, superior shoulder and Clavicle
C5 - skin over the lateral shoulder/ Deltoid towards base of Thumb
The treatment of Scapulothoracic Joint Elevation dysfunction should be specific to the underlying cause. For rehabilitation of common underlying conditions such as Scapular Dyskinesis , Subacromial Impingement or Glenohumeral Joint restriction, see their respective pages.
The following Stretching techniques may directly or indirectly improve Scapulothoracic Joint Elevation restriction:
Bent Over Lat Stretch - accessible active stretch with large GH Joint - Flexion or Horizontal GH Joint - Adduction range
Door Frame Shoulder Stretch - self-guided anterior shoulder stretch with large Horizontal GH Joint - Abduction range
Split Stance Biceps Stretch - self-guided anterior shoulder stretch with large GH Joint - Extension range
Seated Thoracic Rotation with Breathing - large lateral flexion and rotation range coupled with breathing
Banded Capsule Rolls - split stance biceps variation that emphasises shoulder rotation
Shoulder Dislocates - mobility exercise that emphasises the greatest circumduction range possible
Wheel Pose - full bridge variation that lengthens entire anterior chain
Dead Hangs - whole body traction for Pull and Push muscles with large overhead range
As a specific training protocol relates to the underlying cause of Scapulothoracic Joint Elevation dysfunction, the following lists elevation-based Strength exercises in rough descending order from most rudimentary:
Shrug - weighted isotonic exercise that emphasises Scapulothoracic Joint - Elevation
Circumduction Row - isotonic exercise with variable load used to emphasise mid-to-lower Trapezius
Upright Row - weighted isotonic vertical pull exercise that emphasises Upper Trapezius and Deltoid
Farmers Carry - upperbody/ Core isometric exercise with perturbation of walking
Suitcase Carry - unilateral farmers carry which emphasises crossbody functional patterns
The following Mobilisation techniques may be relevant in the treatment of Scapulothoracic Joint Elevation: Joint Play
Scapulothoracic Depression Glide - for excessive Elevation
Scapulothoracic Elevation Glide - for restriction
Sternoclavicular Inferior Glide - for restriction
Posterior Glide on Humerus - to address associated Posterior Glenohumeral Joint Capsule restriction if present
Acromioclavicular Joint - to address general restriction
Cervical Spine - for instances of Radiculopathy a PACVP , PAUVP or TVP may be applied to relevant Cervical segment(s) in addition to the following techniques:
Mobilisation with Movement - mobilisations applied with active movement
Shoulder - MWM 1 - Scapulothoracic Elevation with Clavicle glide
Shoulder - MWM 2 - Scapulothoracic Elevation with Clavicle glide
Sleeper Stretch MWM - self-guided Posterior Capsule release
Cervical Spine - for suspected Radiculopathy , the following techniques may be indicated:
SMWAM - Cervical mobilisations with arm movement
Neurodynamic SMWAM - Cervical mobilisations with neurodynamic arm movement
Cervical SNAGS - Cervical mobilisations with neck movement
NAGS - particularly useful for restriction or Pain associated with movement for C2-C7
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