The Upper Extremity 395Alignment and Common Deviations of the Shoulder Complex
With normal alignment of the shoulder complex, the
clavicles should be approximately horizontal, while
the scapulae lie flat against the rib cage posteriorly
and extend from approximately the second through
the seventh rib (Rasch and Burke, 1978). Various
deviations from this ideal alignment occur, includ-
ing rolled shoulders and winged scapulae. Because
these deviations are often associated with muscular
imbalances, their occurrence is widespread, but they
are generally more readily corrected than some of
the deviations seen at other joints that involve more
permanent structural elements.
Rolled Shoulders
Rolled shoulders involves a forward rounding of
the shoulders that usually encompasses a position
of excessive scapular abduction and often internal
rotation of the humerus (figure 7.19). Correction
requires strengthening of the scapular adductors
(especially the trapezius and rhomboids) and in
some cases stretching of the scapular abductors
(particularly the pectoralis minor). When internal
rotation of the humerus is also present, strengthen-
ing of the external rotators and stretching of the
internal rotators (especially the pectoralis major
and latissimus dorsi) can also be helpful. When
rolled shoulders is a chronic posture, kyphosis is also
frequently present, and strengthening of the upper
back extensors (see chapter 3) is necessary. Several
exercises for helping prevent and correct rolled
shoulders are shown in figure 7.20 and described
in tables 7.10 and 7.12. Double-shoulder external
rotation (figure 7.20B and table 7.10I, progression 3,
p. 439) offers a time-efficient exercise that combines
shoulder external rotation, scapular adduction, and
thoracic extension in a single exercise. The single-
arm scarecrow (figure 7.20C and table 7.10H, varia-
tion 2, p. 439) provides an exercise for developing
shoulder external rotation while maintaining torso
stability when the arm is at shoulder height, a posi-
tion commonly required in dance. Stretches to help
improve rolled shoulders include the sitting arms
overhead shoulder stretch (figure 7.20A and table
7.12C, variation 1, p. 450) and kneeling arms overhead
shoulder stretch (described later in table 7.12B, p.
449), which emphasize stretching of the latissimus
dorsi and lower fibers of the pectoralis major, as well
as the wall shoulder stretch (described later in table
7.12D, p. 450), which emphasizes stretching of the
anterior deltoid and the pectoralis major. In addition
to exercises, cueing to bring the scapulae slightly
down and together while one reaches the shouldersFIGURE 7.19 Shoulder alignment. (A) Rolled shoulders; (B) desired shoulder placement.