Name: Shoulder External Rotation Goniometry
Uploaded: 2023-04-26T01:00:15.000Z
Duration: 9 min 2 s
Description: Master shoulder external rotation measurement with goniometry. Boost strength and mobility with our comprehensive video tutorial. Perfect your technique today!

English captions

https://stream.mux.com/6FMYjzIlps4RiX9YRkSiVonIRvUuT4lmPJ0001TjxZktY.m3u8

Master shoulder external rotation measurement with goniometry. Boost strength and mobility with our comprehensive video tutorial. Perfect your technique today!

Introduction to Glenohumeral External Rotation Assessment

External Rotation Measurement Technique

Interpreting External Rotation Results and Implications

Factors Affecting External Rotation Range of Motion

Addressing Limitations in External Rotation

Conclusion and Application of Techniques

Shoulder External Rotation Goniometry

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

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Videos

Goniometry of the upper body, including shoulder flexion, extension, internal rotation, external rotation, and cervical spine goniometry. A list of potential muscles, fascia, and neural structures that may restrict motion at the shoulder and spine.

Shoulder External Rotation Goniometry

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Shoulder Internal Rotation Goniometry

Shoulder Extension Goniometry

Shoulder Flexion Goniometry

Hip Abduction Goniometry

Hip Flexion Goniometry

Hip Extension Goniometry

Goniometry: Hip External Rotation at 90 Degrees of Hip Flexion (90/90 Hip ER)

Goniometry: Hip Internal Rotation at 90 Degree of Hip Flexion (90/90 Hip IR)

Goniometry Hip External Rotation (in Prone)

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