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Apley's Scratch Test

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Apley's Scratch Test is a physical exam maneuver used to identify possible knee injuries. The patient is asked to lie on their stomach, and the examiner places one hand on the knee, pressing firmly. With the other hand, the examiner uses a thumb to apply firm pressure on the back of the knee and the heel of the hand applies pressure to the front of the knee. The patient is asked to flex and extend their knee, which causes the examiner to scratch the back of the

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Transcript

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This is Brent of the Brookbush
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Institute, and in this video we're going to
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go over the Apley's scratch test. A great quick test for assessing shoulder
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mobility. These are combined movement tests, so I think you'll find they're very
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useful as pre to post tests, especially in those individuals who have just a
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little bit of dysfunction, but are already starting to have symptoms of
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pain. I'm going to have my friend Melissa come out, she's going to help me
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demonstrate this test. I'm going to start with you having facing your back to the
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camera. Now what Melissa is going to do is we're going to use combined motions
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at the shoulder, to see if she actually has all the mobility she's supposed to
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have. We're going to start with flexion abduction, and of course external
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rotation here, as I asked her to place her hand on the opposite superior angle
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of her scapula or reach down her back, optimal range of motion would be at
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about T7, or able to touch that superior angle without any compensation. So I'm
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going to have you turn sideways. What you guys will notice is her thoracic spine
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is still nice and straight. We have no scapular elevation or scapular anterior
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tipping. So that's the first test. I'm gonna have you go ahead and turn your
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back to the camera, again I can then have her, let's go ahead and combine the rest
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of the joint actions which would be extension adduction, and of course now
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she's in maximal internal rotation as she reaches up back towards T7, or the
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inferior angle of the opposite scapula is a good cue, and again if you guys look
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at it from the side, I want no anterior tipping, or at least very little anterior
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tipping. No elevation of the scapula and then if you guys look this way, I'm also
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going to look at this scapular winging, and you can tell
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Melissa here has a bit of scapular winging, so I might write that down in my
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notes. Her over hand looked pretty good, her under hand she had some scapular
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winging, which might be a sign that she's lacking some internal rotation or
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lacking some extension that we're going to then need to work on. As well as
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helping her to stabilize her scapula with maybe something like serratus
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anterior activation. Now there is many combinations to this test, many different
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ways to do this test. I've seen individuals do okay. So let's try to get
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you to go one under and one over, and touch your fingertips, and you can see
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Melissa can actually touch way more than our fingertips, which is actually not a
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good thing. This is this is hypermobility with this is the cow face pose in yoga.
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Alright so the cow face pose where you trying to hold wrist to wrist, realize
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that's going to come at a price. If you try to get wrist to wrist and get
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hypermobility that's going to lead to dysfunction and pathology, and
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eventually pain, which might lead you back into here. I have to say yoga
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actually gets me as many clients as a physical therapist as any of the
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high-intensity training modalities out there right now. Alright so we can go
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this way, can you do the other way, maybe we just want to test if it's even. We can
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see she's hypermobile on both sides that's that's good, a little bit of
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stability work on maybe. I could compare sides by maybe going both over right, so
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can she touch her the superior angles on opposite sides this way. Can she go both
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under
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and we can see actually she has scapular winging on both sides. So she's very
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symmetrical which is nice, but we do have some stability issues that I would want
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to look into, where she's hypermobile when we do this way we see way too much
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mobility. We see some scapular winging when she goes underneath which I'm going
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to want to check into further as well. Now as a trick to help you differentiate
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whether somebody truly has enough mobility to touch the opposing superior
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angle or opposing inferior angle, without going into anterior tipping and thoracic
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flexion, a little mean trick you can play on people. ls have them go toes to
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the wall, and nose up to the wall. Well not quite that, just toes to the wall
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alright, and now can they reach over and back, good, and she can, she can reach down
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to t7 pretty good. So when it comes to the combined motion of once again
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flexion, abduction and external rotation Melissa has good mobility. And if I'm
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thinking through all of my muscles and arthrokinematics, and Melissa here I know
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that she has plenty of extensibility through those structures. Now if I have
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her do the same thing the other way she's not gaining that mobility through
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her thoracic spine, or through anterior tipping of her scapula. Although she is
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getting, i take that back, she is getting scapular winging which would be a sign
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of anterior tipping, we know it's not coming from her thoracic spine because
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she's not bouncing her head off the wall. So this is a way to make the Apley's
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scratch test a little stricter. Now as part of a physical therapy examination
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for shoulder pain, especially with an athletic population who doesn't need
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very much dysfunction to become painful, you guys can add overpressure to these
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tests. So if I have, go ahead and stand back from the wall, if I have Melissa go
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ahead and let's say reach up with this hand, and touch the opposite, and then what i
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can do is i can stabilize her scapula, take her other elbow,
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and I'm going to push her further back into flexion, abduction, and external
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rotation. Is that painful? If it's not painful i can add overpressure for this
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range of motion that I know she's clear. I had the same thing if I have a reach
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under. I'm going to now take this hand and I'm going to reach underneath her
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forearm as I stabilize this scapula here, and I'm going to pull her into adduction,
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extension, and external rotation. Is that painful? Okay so she's clear through her
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shoulder joint. So I know I just showed you a lot of variations of this supposed
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quick test, or suppose to be quick test, didn't become a very quick video. So she
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has reach over, reach under, those are the basics. You can then combine the two
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shoulders however you want to look at them. You might have a reason to do
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opposites, looking specifically it may be thoracic spine mobility, or maybe this is
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a pose that they're trying to get back to in yoga, but try to keep in mind of
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what I said hypermobility can be very problematic too. You might have a
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reason to do both the same way, maybe this is painful for them on both
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shoulders, so this is the easier quick test. Or this is painful for both
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shoulders like an impingement syndrome, Maybe this is painful on both shoulders
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and this is your better quick test, and of course if somebody has pathology and
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shoulder pain, you can use this as a combined motion joint exam. In which case
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that have you do either reach up or reach under, and then I neither add
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overpressure this way, go ahead and switch.
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Or I might add overpressure this way. You guys need to work out the math on these two.
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As far as what is short, if you can't get into flexion, abduction, and external
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rotation; or adduction, extension and internal rotation, make sure you had that
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worked out at some point so that you can go back and write a corrective exercise
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program. I'll talk with you guys soon.