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