Hypermobility, Scapular Dyskinesia & Shoulder Instability: Understanding the Connection

If you have joint hypermobility, shoulder instability, or recurrent shoulder pain, you may have noticed that your shoulder blade doesn’t always move the way you expect it to.

One common finding is scapular winging.

But what exactly is happening, and why can this be more common in people with hypermobility?

What Is Scapular Dyskinesia?

The scapula, or shoulder blade, plays an important role in creating a stable foundation for movement of the shoulder and upper extremity.

Scapular dyskinesia refers to altered or abnormal movement of the shoulder blade.

One presentation of this is scapular winging, where the shoulder blade appears to lift or protrude away from the rib cage rather than maintaining an optimal relationship with the ribs during movement.

If you’re watching the accompanying video, can you see the scapular winging?

Hypermobility & Shoulder Instability

For people with hypermobility, maintaining stability at the shoulder can be particularly challenging.

The shoulder is naturally one of the most mobile joints in the body. When someone also has increased joint mobility, the muscles surrounding the shoulder may need to work harder to provide stability.

This can contribute to altered movement strategies.

Scapular dyskinesia may sometimes develop as a compensatory movement pattern—the body is attempting to find stability or avoid painful positions.

At the same time, altered scapular mechanics can potentially contribute to ongoing shoulder symptoms.

This creates an important clinical question:

Is the altered movement contributing to the pain, or is the body changing its movement because of the pain?

Sometimes, it can be both.

The Role of the Serratus Anterior

One muscle that plays an important role in scapular control is the serratus anterior.

The serratus anterior helps maintain the scapula against the rib cage and contributes to appropriate upward rotation and movement of the shoulder blade during upper-extremity activities.

For someone experiencing hypermobility and shoulder instability, improving the ability to appropriately recruit and coordinate the serratus anterior may help support more efficient scapular mechanics.

However, treatment shouldn’t simply be about “strengthening one muscle.”

For people with hypermobility, physical therapy should consider the entire movement system, including strength, motor control, proprioception, stability, breathing mechanics, and the individual’s specific movement patterns.

What Can Physical Therapy Do?

A physical therapist can assess how the shoulder blade, shoulder joint, rib cage, and surrounding muscles are working together.

Treatment may include exercises designed to improve:

• Scapular control
• Serratus anterior activation
• Shoulder stability
• Proprioception
• Motor coordination
• Strength and endurance
• Functional movement patterns

The goal isn’t necessarily to make the shoulder less mobile.

Instead, the goal is to help the body develop better control over the available range of motion.

For people with hypermobility, learning how to create stability through coordinated muscle activation can be an important part of managing shoulder symptoms and improving function.

The Takeaway

Hypermobility + scapular dyskinesia + shoulder instability can create a complex cycle of altered movement and pain.

Understanding how the scapula interacts with the rib cage and shoulder joint can help clinicians develop more individualized treatment strategies.

If you experience shoulder instability, recurrent shoulder pain, or noticeable scapular winging, consider having your movement patterns evaluated by a physical therapist familiar with hypermobility and shoulder instability.

Reference: PMC – Scapular dyskinesis and shoulder instability research