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Shoulder Extension Goniometry

Shoulder Extension Goniometry is an assessment tool used to measure the range of motion of the shoulder joint. It is commonly used by physical therapists and doctors when screening patients with shoulder injuries or to evaluate progress of rehabilitation from shoulder surgery. The measurements obtained from shoulder extension goniometry are valuable in diagnosing shoulder joint pathology, assessing shoulder joint function, and creating individualized treatment plans for shoulder injuries.

Transcript

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This is Brent of the Brookbush Institute at the
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independent training spot. Today we're
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doing shoulder extension goniometry. now for shoulder extension we have a
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firm end feel, it's like pulling leather to its end range you get a lot of
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resistance, and then a pretty firm stop, and you guys will notice that I have 20
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to 25 degrees of shoulder extension written down as being optimal. Now if you
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open up a textbook often shoulder extension goniometry is listed at 60
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degrees. The reason being is that includes free motion of the shoulder
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girdle, that is it allows anterior tipping to occur as much as it can, plus
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glenohumeral extension. Now from what I've seen guys and you might work in a
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different clinic with a different audience, and and that makes perfect
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sense for what you're working on, what I see is a lot of this when people walk in.
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They already have an excessive amount of anterior tipping, so if i'm going to do
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shoulder extension I don't want to include a range they might be hyper
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mobile in. Alright so they might be stealing range of motion from their scapula and
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still be restricted at the shoulder, and I wouldn't know. So I do pure
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glenohumeral shoulder extension, which is why you see such conservative numbers.
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I'm going to have my friend Melissa come up she's going to help me demonstrate this
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technique. Alright so the the different thing about this technique from some of
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our other shoulder goniometry techniques is we have to not only
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depress the scapula, but now we have to stabilize the scapula and keep it from
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once again going into anterior tipping. So I'm gonna use my inner thenar
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eminence here right, the space right here to press down on her inferior angle and
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basically posterior tip it, flatten it down to her rib cage. I'm then going to
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go ahead and pull her into shoulder extension but I'm not going to do it by
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her wrist. If I do it by her wrist I'm going to heavily bias this test towards one
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her biceps brachii, and two potentially some nerves right. This kind of looks
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looks like the beginning of that radial and median nerve test if I were to flip
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her over. So because I want to see everything that's kind of going on at
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the shoulder, I want to see how her glenohumeral joint specifically is
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affected, I'm going to go ahead and take two fingers lift her up at the elbow,
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allow her to go into some elbow flexion so that at least those structures that
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we just talked about the biceps brachii and some of the nerves of your arm, have
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a little bit more room to move and I get a little bit more general sense of what
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is blocking shoulder extension. So we're going to brace, press down into the
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ribcage, and then pull her up by your elbow. I'm going to flip around here and
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show you guys what this looks like.
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Alright so I'm going to use this hand and hand closer to my patient, depress her
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scapula, and then go ahead and push her into posterior tipping, basically
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flattening her scapula into her rib cage. I'm then going to use this hand to pull
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her into shoulder extension from the elbow, making sure I cue her to relax. This
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is one of those those ranges of motion that people like to help you, and we want
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to make sure we get passive range of motion here. I actually like to use my
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thigh right up against the table to make sure they don't go into abduction. I can
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kind of keep around the sagittal plane here making sure she doesn't try to
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internally rotate and abduct, she doesn't externally rotate on me, I get nice pure
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shoulder extension. Once I get her there, I'm going to have her hold, can you hold
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that for me good. We're then going to line up our pivot point here with the
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center of the the shoulder joint, as close as we can estimate. The movement
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arm goes through this orange line that I've taped for you guys here which is
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just the midline, the lateral midline of the humerus to lateral condyle, and then
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the stabilization arm is mid-axillary line perpendicular to the table, make
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sure I'm eye level with my measurement and I get 22 degrees.
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So I'll show you guys that a little bit faster this time just like I would run
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through it in my own practice. We're going to push down, stabilize, pull up, oh
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don't help me, good can you hold that, cool all right
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and that time I got 20 degrees. That's within 2 degrees, either way she has
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normal range of motion right, she's she's within that 20 to 25 degrees. Thank you
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Melissa. So let's talk about what it would mean if like let's say I did this
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measurement and Melissa had 12 degrees of shoulder extension, well that means I
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have some sort of restriction right. This goniometry in general helps us
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identify structures that could be restricted that we could then create
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interventions for. I'm going to take you guys through the same paradigm that I've
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taken you through in all the other videos, we're going to do muscle, joint
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fascia, nerve. Let's start with muscles, we got PEC major think about how many
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individuals come in with a short and overactive PEC major right, this position.
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Anterior deltoid, this is one of the few tests that we have that actually
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implicates this structure which is kind of interesting, you know can somebody
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have shortness and tightness in that anterior deltoid that maybe needs to be
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treated out, so that we get optimal movement back and a reduction in symptoms.
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The coracobrachialis another interesting muscle that isn't implicated many of our
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other tests, our coracobrachialis is is one of those hidden structures that's
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often forgotten, it may be worth checking out if you have somebody who's had a
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little bit of stubborn shoulder pain, or they had that upper body dysfunction
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that that you having a hard time relieving them of. Before I get to post
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deltoid let's talk about joint real quick. So joint we have the anterior capsule
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could be restricting, we have the coraco- humeral ligament which is probably
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actually why we get a firm end feel on this particular range of motion. If we
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probably hit a hard end to this ligaments extensibility. And then we get
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down here guys and you'll see two structures that I have starred, and
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that's the posterior capsule and posterior deltoid, and if you're thinking
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through this like I am you guys are already going wait a second if I go on
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to shoulder extension I'm shortening these two things,
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why does he have listed as possible restrictions. Well the truth of the
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matter is is what can happen for this range of motion, is often the humerus the
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humeral head will shift anteriorly in the glenoid fossa all right, we have an
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anterior migration of that humeral head which means the anterior capsule is
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actually not short in that scenario it's been lengthened, but because it's already
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been lengthened by for word translation, when you pull into extension you hit the
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end of the anterior capsules extensibility. The reason that's
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occurring is because we actually have posterior deltoid overactivity, an adaptive
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shortening of the posterior capsule basically squeezing the humeral head
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forward. So if you're looking at some of these structures, you've been working
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with some of these structures with whatever techniques you're comfortable
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with you're not getting your results, check this out. Sometimes all you have to
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do is is that self-administered posterior deltoid release, maybe a little
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bit of a sleeper stretch, and shoulder extension miraculously goes back to
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optimal. Now fascia for all of all of you guys using ART and our
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instrument assisted soft tissue mobilization, and pin and stretch and all
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of the different fascial techniques that are out there, don't forget about all of
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the covering fascia in this area right. You have all of this stuff, all of this
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stuff all that fascia that comes down into that that pectoral deltoid triangle,
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right all of this anterior deltoid fascia that tends to get restricted. You know if
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we're going to come up with an example and all of my individuals who do this
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all day, all right we might want to loosen or start unbinding all of that
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tissue in there. And then of course guys if I had pulled Melissa up into shoulder
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extension she started getting tingly and numb, tingling, numbness parasthesia,
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pins and needles, I need to go ahead and break out into those upper limb
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tension tests. I need to see if maybe my brachial plexus is involved in some of
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this limitation, or some of the nerves of the arm. So once again big list, some
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complicated arthrokinematics here, but nonetheless you know how I like you
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guys to think of this. This isn't something for you guys to panic about,
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it's not something for you guys to be overwhelmed by, I want you to look at
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this chart and go I have a lot of opportunities and potential solutions to
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help correct a movement impairment, in this particular video shoulder extension.
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I hope to hear about great outcomes thank you.