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)