summary Scapulothoracic dyskinesis is a rare condition characterized by abnormal scapula motion leading to shoulder impingement and dysfunction. Diagnosis is clinical with presence of scapulothoracic crepitus with a low and protracted scapulaand symptoms being relieved with scapula stabilization. Treatment involves NSAIDs and physical therapy with emphasis on periscapular muscle and rotator cuff strengthening. Epidemiology Demographics seen in athletes (baseball pitchers) Etiology Pathophysiology causes are multifactorial including neurologic injury pathologic thoracic spine kyphosis periscapular muscle fatigue poor throwing mechanics secondary to pain (shoulder, neck) pathoanatomy scapulothoracic power imbalance leads to protraction of scapula leads to alteration of mechanics at glenohumeral joint excessive stress placed on anterior capsule of shoulder and posterosuperior labrum athletes have increased risk of injuring labrum rotator cuff capsule Anatomy Scapulothoracic joint anatomy Presentation Symptoms shoulder pain and dysfunction worse with arm elevation loss of throwing velocity Physical exam scapulothoracic crepitus affected scapula may be lower and protracted symptoms relieved with scapula stabilization Imaging Radiographs recommended views complete shoulder series findings usually unremarkable Treatment Nonoperative NSAIDs, PT, local injections indications main treatment technique physical therapy with emphasis on core strengthening scapular stabilizers, serratus anterior, trapezius rotator cuff muscles teaching proper core mechanics in throwers