Author Archives: John Castle

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Rhomboids

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Rhomboid

Posterior Right

The rhomboid muscles adduct and downwardly and (medially) rotate the scapula. The rhomboids, like the levator scapula, are both synergists and antagonists of the trapezius.  The rhomboids typically become more dominant than the trapezius and will restrict upward rotation of the scapula.  Depressed shoulders are a common postural impairment, which leaves the upper trapezius frequently overstretched and weak.

Shoulder shrugging exercises with the arms down only reinforces the dominance of the rhomboids and levator scapula.  To emphasize upper trapezius activity shoulder shrugging should be done with the arms overhead so that the scapula is upwardly rotated. Continue reading →

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Pectoralis Minor

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The pectoralis minor muscle tilts the scapula forward (anteriorly) by pulling the coracoidPectoralis Minor process forward and downward (caudally).  Shortness of this muscle interferes with upward rotation of the scapula and can restrict elevation of the rib cage.  If the abdominals are short and stiff, this restriction is even more exaggerated, adding greater resistance to movement of the scapula.

Shortness of the pec minor can also contribute to thoracic outlet syndrome (TOS).

This muscle is difficult to stretch because pressure must be applied at the coricoid process, not the humerus.

When correcting the scapular position, the glenohumeral joint must remain in neutral position.  the emphasis must be on posterior tilt and not adduction of the scapula.

 

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Levator Scapula

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Right Posterior

Right Posterior View

The levator scapula muscle adducts and downwardly (medially) rotates the scapula and is a synergist of the trapezius for adduction but an antagonist for rotation.

The levator scapula (LS) attaches to the transverse processes of the first 4 cervical vertebrae, and can restrict cervical rotation, but in the presence of excessive cervical joint flexibility may rotate the cervical spine during shoulder motions.

During shoulder flexion, the LS is stretched as the scapula upwardly rotates.  If the LS is ‘stiff’ (limited extensibility) the stretch of the muscle can rotate the head to the ipsilateral  (same) side.

Because this muscle attaches to the medial aspect of the superior angle of the scapula.  Shortness of this muscle can limit upward rotation of the scapula and can give the impression of an elevated shoulder when observing the shoulder height near the base of the neck.

The attachment of the LS to the superior angle of the scapula can elevate the most medial portion of the scapula but does not elevate the acromial region.  During shoulder flexion, the LS is stretched as the scapula upwardly rotates.   The LS can elevate the most medial portion of the scapula, but does not elevate the acromial region.  It is also important to differentiate between shortness of the levator scapula and rhomboids versus the upper trapezius in the treatment phase.  Continue reading →

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Scapular Downward Rotation

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Insufficient scapular upward rotation is the primary movement impairment in this syndrome. The scapular position may be downwardly rotated, adducted, abducted, or normal.  This movement impairment may be evident at any point during the range of motion.  Muscle impairments include dominance, shortness, or stiffness of the downward rotator muscles [e.g., rhomboids, levator scapula, latissimus, pec minor/major] and insufficient activity of the upward rotators [e.g., serratus anterior, trapezius], (Sahrmann, 2004).

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Scapular Depression

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The primary movement impairment in this syndrome is insufficient scapular elevation.  Initial scapular alignment may be depressed with a failure to elevate sufficiently during movement, or scapular alignment may be normal. Depression occurs during arm elevation.  Muscle impairments include dominance, shortness, or stiffness of the scapular depressor muscles [e.g., latissimus, pecs, lower trapezius], and insufficient activity or lengthened scapular elevator muscles [e.g., upper trapezius and possibly levator scapula]. (Sahrmann, 2002)

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Scapular Abduction

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The primary movement impairment in this syndrome is excessive scapular abduction.  Muscle impairments are a dominance of scapular abductor muscles (pec major, serratus anterior) and insufficient activity of the scapular adductor (primarily trapezius) muscles, primarily their alignment and appearance. (Sahrmann, 2002)

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Scapular Winging and Tilting

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The primary movement impairment in this syndrome is excessive scapular abduction.  Muscle impairments are a dominance of scapular abductor muscles (pec major, serratus anterior) and insufficient activity of the scapular adductor (primarily trapezius) muscles, primarily their alignment and appearance. (Sahrmann, 2002)

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Humeral Anterior Glide

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Excessive anterior or insufficient posterior glide of the of the humeral head is noted during shoulder motions.  This syndrome may be associated with laxity of the anterior structures and stiffness or shortness of the posterior structures of the GH joint.  The subscapularis is frequently lengthened or weak and the posterior deltoid dominates over infraspinatus and teres minor muscles.  The muscles that attach further from the axis of rotation (e.g., pectoralis major, latissimus, teres major) dominate over the subscapularis. (Sahrmann, 2002)

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Humeral Superior Glide

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Excessive superior or insufficient inferior glide of the humeral head is noted during shoulder motions.  This may be associated with stiffness or shortness of the superior or inferior structures of the GH joint.  Insufficiency of the rotator cuff because of weakness, recruitment impairments, or tear is a major causative factor. This disrupts the normal force couple between the rotator cuff and the deltoid. (Sahrmann, 2002)

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