Is there a relationship between subacromial impingement syndrome and scapular orientation?

Changes in scapular orientation and dynamic control, specifically involving increased anterior tilt and downward rotation, are thought to play a substantial role in contributing to a subacromial impingement syndrome (SIS). The goal of non-surgical intervention is restoring normal scapular posture. The research evidence supporting this practice is equivocal. This study’s goal was to systematically review the relevant literature to examine whether a difference exists in scapular orientation between people without shoulder symptoms and those with SIS. MEDLINE, AMED, EMBASE, CINAHL, PEDro and SPORTDiscus databases were searched using relevant search terms up to August 2013. Additional studies were identified by hand-searching the reference lists of pertinent articles. Of the 7445 abstracts identified, 18 were selected for further analysis. Two reviewers independently assessed the studies for inclusion, data extraction and quality, using a modified Downs and Black quality assessment tool. 10 trials were included in the review. Scapular position was determined through two-dimensional radiological measurements, 360° inclinometers and three-dimensional motion and tracking devices. The findings were not consistent. Some studies reported patterns of reduced upward rotation, increased anterior tilting and medial rotation of the scapula. In contrast, others reported the opposite, and some identified no difference in motion when compared to asymptomatic controls.


The underlying aetiology of SIS is still debated. The authors’ findings in this review showed a lack of consistency of study methodologies and results. At this time, there is not sufficient evidence to support a clinical belief that the scapula adopts a common and consistent posture in SIS. This may reflect the complex, multifactorial nature of the syndrome. It may also be due to the methodological variations and shortfalls in the available research. It also brings up the possibility that deviation from a ‘normal’ scapular position may not be contributory to SIS but part of normal variations. Further research is needed to establish whether a common pattern exists in scapular kinematics in SIS patients or whether subgroups of patients with common patterns can be identified to guide management options. Non-surgical treatment involving rehabilitation of the scapula to an idealised normal posture is not supported by the available literature at this time.