Rol De Las Escapula En Rehabilitacion De Hombro

en la Journal of Athletic Training 2000;35(3):364 –372
© by the National Athletic Trainers’ Association, Inc
www.journalofathletictraining.org

The Role of the Scapula in the
Rehabilitation of Shoulder Injuries
Michael L. Voight, DPT, OCS, SCS, ATC; Brian C. Thomson, SPT
Belmont University, Nashville, TN
Objective: To present a clinical understanding of the role the
scapula plays in themechanics of shoulder function and
specialized techniques for the rehabilitation of injuries around
the shoulder girdle.
Background: The scapular musculature is often neglected in
the evaluation and treatment of shoulder injuries. This lack of
attention often degenerates into the incomplete evaluation and
rehabilitation of scapular dysfunction. Dysfunction or weakness
of the scapularstabilizers often results in altered biomechanics
of the shoulder girdle. The altered biomechanics can result in
(1) abnormal stresses to the anterior capsular structures, (2) the

increased possibility of rotator cuff compression, and (3) decreased performance.
Description: We review the anatomy and role of the scapula,
the pathomechanics of injury and dysfunction, and the evaluation andrehabilitation of the scapula.
Clinical Advantage: Knowledge of how the scapular muscles influence function at the shoulder builds a strong foundation for the clinician to develop rehabilitation programs for the
shoulder.
Key Words: scapular rehabilitation, shoulder rehabilitation,
impingement syndrome, rotator cuff

T

attachments at the acromioclavicular joint and through a
suction mechanismprovided by the muscular attachments of
the serratus anterior and subscapularis.2 This suction mechanism holds the scapula in close proximity to the thorax and
allows it to glide during movements of the joint.2
While many muscles serve to stabilize the scapula, the
main stabilizers are the levator scapulae, rhomboids major
and minor, serratus anterior, and trapezii. The glenohumeral
protectorsinclude the muscles of the rotator cuff: the
supraspinatus, infraspinatus, teres minor, and subscapularis.4 – 8 These muscle groups function through synergistic
cocontraction to anchor the scapula and guide movement.
The scapula moves through a gliding mechanism in which
the concave anterior surface of the scapula moves on the
convex posterolateral surface of the thoracic cage.2 Thesemuscles work together to coordinate the balance of movement between the shoulder joints, thereby maintaining
scapulohumeral rhythm.4,6,9 When the muscles are weak or
fatigued, scapulohumeral rhythm is compromised, and
shoulder dysfunction results.4,8,10 This dysfunction can
cause microtrauma in the shoulder muscles, capsule, and
ligamentous tissue and lead to impingement.3– 6
During all movementsof the glenohumeral joint (especially
movements involving more than 90° of flexion or abduction),
it is of paramount importance that the scapular-stabilizing
musculature be strong enough to properly position the scapula.
For example, the biomechanical research of both Jobe and
Pink6 and Bak and Faunl10 demonstrated that if weakness or
fatigue of any of the aforementioned structures occurs,scapulohumeral rhythm is disrupted, and secondary impingement
(defined as a relative decrease in the subacromial space due to
instability of the glenohumeral joint or functional scapulothoracic instability) ensues.4,10 Thus, the role of the scapula in
upper extremity function must be considered in any shoulder
rehabilitation program.

he role of the scapula in upper extremity function hasreceived considerable interest in recent years as our
knowledge of the shoulder and surrounding structures
has increased. The scapula plays several roles in facilitating
optimal shoulder function when scapular anatomy and biomechanics interact to produce efficient movement. In normal
upper-quarter function, the scapula provides a stable base from
which glenohumeral mobility occurs.1...