Scapular Downward Rotation Syndrome

Common Associated Medical Diagnoses:

  • Supraspinatus or Rotator Cuff tendinopathy and impingement
  • Rotator Cuff Tear
  • Thoracic outlet and neural entrapment
  • Humeral subluxation
  • Humeral instabilities
  • Neck pain (with or without radiating arm pain)
  • Pain in the levator scapula and upper trapezius muscles
  • Acromioclavicular joint pain
  • Sternoclavicular joint pain


As you can see from the above list, the pain complaints can be vast and very different.  All of the pain complaints are related to downward scapular rotation at rest or decreased upward rotation during arm elevation.  This indicates the muscles that help cause upward rotation are not working right or the muscles that cause downward rotation are too tight.  The scapula should reach 60 degrees of upward rotation with the inferior angle reaching the midaxillary line of the thorax at the completion of shoulder flexion.

Diagnostic Tests:

  • Decreased scapular upward rotation during arm elevation.
  • Scapular downward rotation at rest.
  • Decreased pain with correct positioning of the scapula at rest.
  • Decreased pain while assisting the scapula into upward rotation during arm elevation.
  • Resistance noted while positioning the scapula into upward rotation.


  • Activate the upper trapezius, lower trapezius, and serratus anterior to work together better to upwardly rotate the scapula.
  • Taping to correct static alignment.
  • Improve the mobility of the rhomboids, levator scapula, and pectoralis minor (the primary downward rotators).



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