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Shoulder External Rotation Goniometry

Goniometry involves measuring shoulder external rotation range of motion to assess shoulder strength and mobility. Learn the correct technique and protocols in this comprehensive video tutorial.

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00:06 - 00:08This is Brent of the Brookbush Institute at the independent training
00:08 - 00:13spot in New York City, bringing you guys more goniometric assessment. In this
00:13 - 00:17video we're going to do shoulder or glenohumeral external rotation. I'm going
00:17 - 00:20to have my friend Melissa come out, she's going to help demonstrate this technique.
00:20 - 00:26Now in this video we're looking for probably 90 to 95 degrees of external
00:26 - 00:30rotation, that's an optimal range of motion I go for. I tend to be fairly
00:30 - 00:35conservative because I'm very strict about how much shoulder girdle or
00:35 - 00:39scapular elevation I will allow. If you guys look in texts you might find a slightly
00:39 - 00:44wider range, and it might be up to your professional discretion to figure out
00:44 - 00:50what is optimal for your clinic, studio, or gym that you're working at. The end
00:50 - 00:54feel is firm, that means when I push your down to that end range, I shouldn't feel
00:54 - 00:58soft squishiness, I shouldn't feel like there's more play there. I should be able
00:58 - 01:03to get to an end range and then feel a pretty solid stop, like I lengthened out
01:03 - 01:08a belt and came to the end like a leather belt came to the end, and it and
01:08 - 01:12it stopped because I couldn't pull it any longer. Now as far as the technique
01:12 - 01:17itself, we want a place for our movement arm, so our movement arm is going to
01:17 - 01:24measure along her ulna from olecranon process to styloid process. Your
01:24 - 01:28stabilization Iarm you can set up a couple of different ways, you can either
01:28 - 01:34go horizontal alright so that your parallel with the table, or you can go
01:34 - 01:38vertical perpendicular to the table. It depends on what you're comfortable with,
01:38 - 01:43where you find that your most accurate with your eyeline. Now I'm going to flip
01:43 - 01:46around the table, my head is going to get cut off here as I show you guys how to
01:46 - 01:51do this measurement, I apologize for that.
01:52 - 02:00First things first I want to set Melissa up at 90 degrees of abduction. Now I tend
02:00 - 02:05to use this hand to make sure that she's depressed at the scapula, get her back in
02:05 - 02:09the neutral position because so many people end up elevated like this as they
02:09 - 02:15lie down. So get her nice and depressed all right, and then I'm going to go ahead
02:15 - 02:19and let her relax but keep my hand there so she can't elevate any further. To keep
02:19 - 02:23her from going into adduction as I pull her into external rotation, I'm going to
02:23 - 02:28go ahead and put my thigh that's kind of a fulcrum. So now I have her stabilized
02:28 - 02:33of the scapula, I have her stabilized here, now I get nice strict external
02:33 - 02:38rotation. I'm going to go ahead and make sure I'm in neutral pronation and
02:38 - 02:45supination here, push her back, find her end range which is right there, go ahead
02:45 - 02:50and have her hold it for me. I'm going to make sure I keep my eye on that range so
02:50 - 03:02she doesn't move, as I move into position to take my measurement and Melissa has 95
03:02 - 03:06degrees. So I would call that optimal external rotation. Once again we'll go
03:06 - 03:11through this nice and quick for you guys, depress the scapula, make sure she's
03:11 - 03:16nice and neutral, hold her scapula there, go ahead and place my thigh here so she
03:16 - 03:22can't go into adduction. Make sure she's in neutral pronation and supination, push
03:22 - 03:27her to the end of external rotation, have her hold but keep my eye on it.
03:27 - 03:33Stabilization on vertical, movement arm from olecranon process, the styloid
03:33 - 03:40process, get eye level with my measurement, and that time I got 94
03:40 - 03:45degrees. I think one degree margin of error is probably pretty good. Thank you
03:45 - 03:52Melissa. So now that we've done a goniometric assessment, why do we do these
03:52 - 03:55assessments. Obviously all of our assessments fall more or less into two
03:55 - 04:00categories, it's either differential diagnosis clearing type assessments, is
04:00 - 04:04this somebody we can help, or it's going to affect our exercise selection.
04:04 - 04:10In this case this is a flexibility assessment, I'm starting to think towards
04:10 - 04:14what mobility techniques I want to use, what structures could be potentially
04:14 - 04:18limiting this range of motion. So starting with muscles, I think you guys
04:18 - 04:24will find that the sub scapula is very very implicated when somebody has a limit in
04:24 - 04:35external rotation in this strict test. So release techniques for the sub scapular.
04:35 - 04:39Teres major can also restrict that external rotation, and I think you guys
04:39 - 04:44know that those have a propensity towards over activity because of this
04:44 - 04:52type of posture. Now we're doing glenohumeral joint external rotation but
04:52 - 04:58it's really almost impossible to isolate the scapular motion, or the glenohumeral
04:58 - 05:04motion from the scapular motion. We do need some PEC major and levator scapulae
05:04 - 05:09mobility in this test to reach optimal, because as Melissa was lying there and I
05:09 - 05:13pushed her into external rotation, her scapula needs to posteriorly tip a little bit as
05:13 - 05:18well. So although these aren't going to have a huge impact on this number, if you
05:18 - 05:23guys are missing a few degrees it may be worth going after those anterior tippers
05:23 - 05:27of the scapula, maybe doing some release techniques, or somepin and stretch, or
05:27 - 05:33even some static stretching to try to get that last bit of range. So now let's
05:33 - 05:37go to the joint itself right, we have the glenohumeral ligaments, the coraco-
05:37 - 05:42humeral ligaments, and the inferior capsule, which all can restrict external
05:42 - 05:48rotation. Now I think these being kind of blended with that anterior capsule of
05:48 - 05:52structure, we're not going to find tightness here all that often, but it is
05:52 - 05:59possible. I think where you'll find more tightness is this posterior capsule, and
05:59 - 06:05a lot of times people will even, they'll get back here, they'll feel restricted but
06:05 - 06:08it's because of tightness or pinching they feel in the back of their shoulder,
06:08 - 06:13and that has to do with the change in the arthrokinematics, they're not able
06:13 - 06:18to spin any further, they're not able to posteriorly glide any further,
06:18 - 06:22and they're almost impinging that posterior capsule, restricting their
06:22 - 06:26external rotation. I know that seems a little counterintuitive, but if you just
06:26 - 06:30can't figure out how to get that last bit of range, don't forget I mentioned
06:30 - 06:35that posterior capsule, very similar to the PEC minor and levator scapulae like
06:35 - 06:42I was talking before. AC and s SI joint mobilizations can be very helpful for that last few
06:42 - 06:48degrees. Don't forget that these guys help get back here by allowing that
06:48 - 06:54posterior tipping of the scapula. Fascia our clavipectoral and pectoral fascia.
06:54 - 06:59So all this fascia in through our PEC, plus the fascia that goes underneath
06:59 - 07:03our PEC and covers over our PEC minor, into this axial area. Fascia can
07:03 - 07:08definitely get a little bound, a little restricted, that's where some of our
07:08 - 07:12static static stretching techniques may come into play, as well as our pin and
07:12 - 07:16stretch techniques, or instrument assisted soft tissue mobilization all
07:16 - 07:21can be very helpful there. And then of course we want to just keep all of our
07:21 - 07:26anatomy in mind here, so muscle, joint fascia, nerve. Although we can't
07:26 - 07:32necessarily pinpoint one nerve here, just pulling down into depression and up into
07:32 - 07:37abduction, is going to lengthen the brachial plexus. If somebody has a
07:37 - 07:43brachial plexus and nerves going through their arm that are already a little
07:43 - 07:48sensitized, and we happen to notice as they pull back this way we get some
07:48 - 07:53tingling or or paresthesia, some some numbness, we might want to go ahead and
07:53 - 07:59do our upper limb tension tests so that we can figure out which nerve is being
07:59 - 08:03bothered, and what other potential problems we may have. In this test we
08:03 - 08:07might have a little bias towards the median nerve, but pretty hard to tell
08:07 - 08:11since we're already putting length all the way up here, and it could potentially
08:11 - 08:16send sensation down any one of those nerves. Now as I said in all of these
08:16 - 08:21goniometric assessment videos, I know these are huge graphs, that's not
08:21 - 08:25something to be intimidated by. That should look like a board of
08:25 - 08:29opportunities to you. These are all structures, they're all opportunities
08:29 - 08:34for you to get somebody back to optimal range of motion, get them moving better,
08:34 - 08:38get the feeling better. I hope I taught you guys a new technique in a clear
08:38 - 08:43manner. I hope you guys will use this today right after watching this video,
08:43 - 08:48and I hope I've given you some ideas on how you might be able to help somebody
08:48 - 08:53that is under your care. I'll talk with you guys soon.

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