Execution
- 1Observe the patient from posterior, anterior, and lateral views with the arms relaxed at the sides.
- 2Compare shoulder height, scapular height, inferior angle level, medial border prominence, scapular tilt, protraction / retraction, and clavicular position side to side.
- 3Ask the patient to slowly elevate and lower the arms if a static asymmetry needs dynamic confirmation.
- 4Look for static winging at rest and dynamic winging with movement or light wall pressure.
- 5Document whether the finding appears structural, postural, pain-related, neurological, or secondary to glenohumeral limitation.
Positive outcome
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Odom et al. (2001) — LSST | poor clinical discrimination | 28-50 | 48-58 | NA | NA |
| Wright et al. (2013) — systematic review | NA | NA | NA | NA | NA |
CommentScapular alignment is useful for describing impairments but weak for diagnosing shoulder pathology. Odom 2001 tested the Lateral Scapular Slide Test (LSST) against clinical shoulder dysfunction in 46 patients; best result was 50% Sn / 58% Sp at 45° abduction with > 1.5 cm side-to-side asymmetry, and the authors concluded LSST should not be used to identify shoulder dysfunction. Wright 2013 systematic review concluded that no scapular physical examination test was useful for differential diagnosis of shoulder pathology. Magee links medial-border winging with serratus anterior / long thoracic nerve dysfunction, and rotary winging / scapular tilt with trapezius / spinal accessory nerve dysfunction, but these are localisation hypotheses, not diagnostic discriminators.