Postural cues for scapular retraction and depression promote costoclavicular space compression and thoracic outlet syndrome

Abstract

A commonly used postural corrective measure is to pull the shoulders back and down. This corrective measure is most likely based upon the idea that postural acromial protraction is a frequent tendency in neck and shoulder patients, as is excessive clavicular elevation during shoulder movement. However, this corrective measure is based upon logical fallacies, firstly because it will cause scapular depression and downward rotation, which has been associated with scapular dyskinesis (SD), shoulder impingement syndrome (SIS) and neck pain. Secondly, biomechanically it will set the patient in the Halstead’s costoclavicular compression (“military brace”) test position, which may result in plexopathy and thoracic outlet syndrome (TOS). The corrective measure thus opposes what it is intended to do, as it may exacerbate neck and shoulder problems rather than ameliorating them. Based on the anatomy and evidence, as well as personal clinical experience with 115 TOS patients, it is my impression that the cue in question is harmful and that its use should be discontinued. Conversely, the patient should be cued to raise his or her scapulae until the superior scapular angles are levelled with the T2 vertebra, and learn to stay there, as this will upwardly rotate the scapulae as well as decompress the costoclavicular space.