Scapulothoracic Retraction is one of several movements available to the Scapulothoracic Joint involves medial gliding of the Scapula with a compliment of Sternoclavicular Joint and Acromioclavicular Joint rotations in the horizontal plane. In layman’s terms, this motion describes drawing the shoulder back/ squeezing the shoulder blades together. Rectraction often occurs as a product of pulling the body towards an object.
Sternoclavicular Joint Capsule
Ventral Arm Chain - restricted
Lateral Arm Chain - Pain ful
Deep Front Arm Line - restricted
Superficial Front Arm Line - restricted
Deep Back Arm Line - Pain ful
Lateral Line - restricted
Spiral Line - restricted
Intuitively, Retraction of the Scapulothoracic Joint occurs in the reverse fashion to Scapulothoracic Joint - Protraction (SOURCE-2+4). As The Shoulder Girdle is drawn posteriorly the Scapula glides medially, following the contour of the Ribs and the Medial Borders become near parallel with eachother and the approaching Vertebral Column . The medial Clavicle glides anteriorly at the Sternoclavicular Joint and the lateral Clavicle is progressively restores its congruency at the Acromioclavicular Joint (SOURCE-2+4).
The Trapezius and Rhomboids are considered the primary Scapula retractors (SOURCE-2+5+6). Despite only the Middle and Lower fibres of the Trapezius being suited to Retraction, all portions display heighened activity during this motion (SOURCE-6). This may be due to the synergistic action of the Upper Trapezius and Rhomboids with the Lower Trapezius who share opposing roles in the vertical plane ( Scapula Elevation v Depression) but a complimentary role in the horizontal plane with Retraction (SOURCE-4+6). Some authors have described the Serratus Anterior as a Retractor; however, this could be due to a display of activity with all Scapula motion as its traditionally described as a Scapulothoracic Joint - Protraction Muscle (SOURCE-1+6).
Hypertonic or restricted tissues may limit the ability of the Scapula to retract. Hypertonicity of the Pectoralis Major , Pectoralis Minor or Serratus Anterior serve as prominent muscular examples (SOURCE-2+5+7+8). In terms of static restraint, the anterior glide of the medial Clavicle (required for Retraction) is limited passively by the Costoclavicular Ligament and Posterior Sternoclavicular Ligaments (SOURCE-2).
During GH Joint - Abduction , insufficient Retraction of the Scapula results in greater Middle Deltoid activity and a corresponding superior migration of the Head of Humerus (SOURCE-6).An increased posture of Scapulothoracic Joint - Protraction also inhibits activity of the Middle and Lower Trapezius while simultaneously increasing activity of the Upper fibres (SOURCE-6). These adaptations predispose a greater risk of pathology, particularly those that relate to Subacromial Impingement (SOURCE-6).
Conversely, exccessive Retraction may be a compensatory response to Anterior Glenohumeral Joint Capsule , GH Joint - Extension or GH Joint - Internal Rotation restriction and/or a lack of Scapulothoracic Joint control (SOURCE-5). Excessive Retraction may exacerbate stress on the anterior capsulolabroligamentous structures to predispose Anterior Glenohumeral Instability , particularly during overhead motions (SOURCE-1).
Both excessive and insufficient Retraction are common forms of Scapular Dyskinesis of which there may be many causes. If persistent, dysfunctional Retraction often falls to an impingement or instability related cascade.
Glenohumeral Instability - increased retraction may be a compensatory response to insufficiency from the Rotator Cuff (SOURCE-5). In excess, this motion may exacerbate stress on the shoulders anterior capsulolabroligamentous structures to predispose anterior instability.
Subacromial Impingement - a failure to adequately retract the Scapula leads to excessive Anterior Scapular Tilting which narrows the subacromial space (SOURCE-10+11). Additionally, the posterior glide of the Humerus associated with Retraction of the Scapula forms an avenue for posterior impingement in compromising positions such as GH Joint - Abduction and GH Joint - External Rotation .
Neuropathy - a common cause of Trapezius insufficiency may is palsy of Cranial Nerve XI which may result from blunt trauma, such as those described in Acromioclavicular Joint Dislocations or more commonly represent a complication of surgical procedures (SOURCE-13+14). Similarly, through innervation of the Rhomboids and Levator Scapulae , Dorsal Scapular Nerve palsy would likely compromise the ability to retract the Scapula (SOURCE-12).
At Rest - resting posture of slight Scapulothoracic Joint - Elevation and Retraction is considered an optimal position for The Shoulder Girdle as it leaves the Glenoid Fossa facing slightly upwards (SOURCE-4)
Scapulohumeral Rhythm - during this motion slight Protraction is considered normal (SOURCE-5)
Snapping Scapula - clicking/ snapping sensation associated with arc of motion between Retraction and Scapulothoracic Joint - Protraction caused by rubbing with underlying Ribs (SOURCE-5)
Retraction of the Scapula is one of several composite motions of The Shoulder Girdle evaluated during Shoulder - Active Range of Motion and Shoulder - Passive Range of Motion assessment. While this Range of Motion is infrequently quantified, over the total arc of Retraction-to- Scapulothoracic Joint - Protraction approximately 10-12cm of Scapula should be available (SOURCE-3).
To perform this movement, the patient is asked to squeeze their shoulder blades together. In the healthy shoulder, the medial borders of the Scapula should remain parallel both to each other and the Vertebral Column (SOURCE-5). As the motion at one joint is often compensated for by the other, Range of Motion of the Glenohumeral Joint should be evaluated, particularly in the presence of restricted Retraction (SOURCE-5). In terms of Isometric Tests , active-resisted Scapulothoracic Joint - Elevation serves as a Myotomes test to evaluate Cranial Nerve XI and C4 .
The following Shoulder - Special Tests may be relevant in the assessment of dysfunctional Retraction: Scapular Dyskinesis
The following tests may be conducted to rule in/out nerve contribution with C4 and C5 Nerve Roots most relevant to Scapulothoracic Joint Retraction: Cervical - Myotomes (active resisted)
Cervical - Dermatomes - evaluates sensory region
Reflex - diminished reflex indicates potential lesion at corresponding Nerve Root
Upper Limb Nerve Tension Tests
The treatment of Scapulothoracic Joint Restriction dysfunction should be specific to the underlying cause. Insufficient Scapulothoracic Retraction can be the result of both a lack of strength in the Retractors and a dominance of the Scapulothoracic Joint - Protraction muscles. For rehabilitation of common underyling conditions such as Scapular Dyskinesis , Subacromial Impingement or Glenohumeral Instability , see their respective pages.
The following Stretching techniques may directly or indirectly improve Scapulothoracic Joint Retraction restriction:
Door Frame Shoulder Stretch - self-guided anterior shoulder stretch with large Horizontal GH Joint - Abduction range
Genie Stretch - rudimentary horizontal adduction stretch
Split Stance Biceps Stretch - self-guided anterior shoulder stretch with large GH Joint - Extension range
Sleeper Stretch MWM - internal rotation stretch combined with Humerus Mobilisation
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
Wheel Pose - full bridge variation that lengthens entire anterior chain
As a specific training protocol relates to the underlying cause of Scapulothoracic Joint Retraction dysfunction, the following lists retraction-based Strength exercises in rough descending order from most rudimentary:
Shoulder Sling - Scapula setting exercise
Prone Cobra - isometric exercise that emphasises Middle and Lower Trapezius
Band Pull-Apart - basic isotonic exercise for Scapular Retractors
Bird-Dog - bodyweight isotonic exercise that emphasises Posterior Sling / Core
Circumduction Row - isotonic exercise with variable load used to emphasise mid-to-lower Trapezius
Seated Row - rudimentary weighted isotonic horizontal pull movement
One Arm Row - unilateral DB version of Seated Row
Bent Over Row - weighted isotonic horizontal pull exercise that emphasises entire posterior chain
Prone Lat Pulldown - Lat Pulldown variation that emphasises Thoracic - Extension
Inverted Rows - rudimentary isotonic horizontal pull exercise that utilises bodyweight
Face Pulls - bilateral isotonic horizontal pull exercise that emphasises GH Joint - External Rotation
Bird-Dog Row - One Arm Row variation that emphasises Posterior Sling
DB Snatch - unilateral isotonic, explosive shoulder exercise with large overhead range
DB Snatch to Step-Up - wholebody DB Snatch variation that emphasises diagonal functional patterns
The following self-guided Myofascial Release techniques may be relevant in Retraction dysfunction:/Self-Guided/:
The following Mobilisation techniques may be relevant in the treatment of Scapulothoracic Joint Retraction: Joint Play
Acromioclavicular Joint - if subtle restrictions are present
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:
Thoracic Spine - mobilisations of the upper segments may improve symptoms of shoulder dysfunction, where a rounded shoulder posture is present (SOURCE-9):
Mobilisation with Movement - mobilisations applied with active movement
AC Joint - MWM 1 - GH Flexion or Horizontal Adduction
Shoulder - MWM 1 - Scapulothoracic Elevation, Gh Flexion, Scaption
Shoulder - MWM 2 - Scapulothoracic Elevation, Gh Flexion, Scaption
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
Thoracic Spine - mobilisations of the upper segments may improve symptoms of shoulder dysfunction, where a rounded shoulder posture is present (SOURCE-9)
Reverse NAGS - particularly useful for pain or restriction associated with movement of the Upper Thoracic region
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