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Shoulder Flexion Goniometry
Shoulder flexion goniometry is a medical evaluation technique used to measure the range of motion in a person's shoulder joint. This measurement is taken through a series of joint motions. During the procedure, an examiner moves the patient's shoulder in multiple directions, such as forward flexion, abduction, and internal and external rotation. With the aid of a goniometer, the range of motion in each direction is recorded, providing a detailed assessment of the shoulder joint and its motion capabilities.
Transcript
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This is Brent of the Brookbush Institute at
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the independent training spot in New
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York City, and we're going over more goniometric assessment. In this video
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we're going to do shoulder flexion, a range of motion that everybody should be
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very familiar with because of its correlation to function. Now we're going
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to go over both glenohumeral flexion, as well as shoulder complex flexion.i'm going to
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have my friend Melissa come out, she's going to help me demonstrate these
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techniques.
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Now notice I said glenohumeral and shoulder complex and I separated those
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numbers, I think some of the confusion and range of motion of the shoulder
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actually has to do with this particular technique. If you stabilize the scapula
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and you're testing just just the shoulder itself just the glenohumeral
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joint, you should be looking for about a hundred and twenty degrees. Now if we
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allow the scapula to move freely the entire shoulder complex, SC joint, AC
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joint and the glenohumeral joint, we should be looking at about a hundred and
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eighty degrees. Now regardless of which technique I'm doing I generally set up
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the same way, and to make sure her her arms nice and straight, and I start with
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her scapula depressor I know she's starting in a good position, and then i'm going to
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use this little groove between my thenar my hypothenar eminence,
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over the top of her little inferior angle of her scapula. Or I can use
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just my thumb, problem with just your thumb although it's easier on the
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physical therapist, sometimes it's harder on the patient because it's a little
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more pokey, but if I'm doing just glenohumeral right, I'm going to only
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take her shoulder up until I start to feel her scapula go up into upward
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rotation. I'm gonna try to brace it, make sure i get to my hard end feel, and then
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i'm going to take the measurement. Now if i'm looking for just general shoulder
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complex range of motion then i might keep my hand there just at a habits sake,
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but i'm going to go ahead and let her move and pull her straight into flexion.
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Now of course I'm only reaching across her so you guys can see on camera, if I
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was going to do this technique from my own personal measurements on one of my
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patients or clients, I'm going to have her scoot towards me as far as she can, and
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i'll usually use my leg and say you know scoot all the way to my leg. Her scapula
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should be on the table, her shoulder should be off the table right. I'm going to
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go ahead and feel for her scapula there and i guess i use the thumb a little bit
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more, once i get her to
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end range which is right there, I'm going to say hold that. Alright she's going to hold that
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for me. I'm going to go ahead and take my goniometer here and the stabilization
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arm is a mid-axillary line right, so you guys can think straight through the
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armpit down to the top of the iliac crest, that line would continue straight
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through the greater trochanter. My fulcrum is going to be as close to me
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estimating the middle of the glenohumeral joint, and then the movement
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arm goes straight through mid line in her arm, and she has a hundred and
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fifteen degrees of glenohumeral flexion. Now i'm going to show you guys because
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in both the instances i just showed you, both reaching across and this way being
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blocked by the board, I didn't show you guys great technique, but I'm going to
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have to turn my back on you to go through this properly. So
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once again I'm going to have her scoot all the way towards me, I'm going to block out with
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my leg here, make sure she doesn't slide right off the table. So her shoulders off,
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but her scapula's on. If i'm doing glenohumeral I'm going to use my thumb here
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alright, I'm going to pull her back just when I feel that end range. I'm going to
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have her hold. Now as i mentioned in other videos i want to get in eye line
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right with her shoulder now, my movement arm is going to go straight through the
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midline of her humerus, fulcrums going to line up through mid glenohumeral joint here, and
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then the mid-axillary line goes straight through the middle of the armpit to the
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top of the iliac crest, straight through the greater trochanter, and hold,, and I
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got 115 degrees. Now a nice general measurement like i said if i was doing
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shoulder complex right, 180 degrees would be a straight line. So i'd start her off,
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all right can she in straight plane go all the way back to the table, if she
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could we already know she has 180 degrees I don't even have to pull out
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the goniometer. If she had gotten stuck let's say here, hold that for me, I
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would just go back through the same technique. A line midway through the
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humerus, mid-axillary line and if she only had that much flexion that would be
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roughly a hundred and forty-five degrees. So hopefully you guys can now see how
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this technique is lined up. Thank you Melissa. Alright so we just did flexion
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goniometry, we got a hundred and forty-five made-up degrees restriction,
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now what do we do right, if we're going to do a test it better either clear us
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as like a lot of our diagnostic tests do, or better have an impact on exercise
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selection, otherwise why are we doing the test. If we're doing goniometry we're
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looking at restrictions, if she's only 145 degrees I know she's restricted
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in flexion. How am I going to get her to move better, well I have to start
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thinking about the things that could restrict flexion. Let's start with
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muscles. So we got some really big muscles right the lats, the teres major,
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part of the PEC major will all restrict shoulder flexion, the subscapularis right
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even though it's just it's an it's listed as an internal rotator in most of
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your textbooks, it will also restrict flexion. The posterior deltoids right as
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we especially get up into this in range can restrict flexion, it can also have a
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a big effect on arthorkinematics and not glide the humeral head posteriorly
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as we go into flexion. And then if we were only doing glenohumeral flexion
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that's would be where this list stopped. But if you did shoulder complex flexion
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right now night now you just don't have shoulder flexion, you have shoulder
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flexion with potentially upward rotation, and posterior tipping alright. So I
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listed the posterior are the anterior tippers here those things with that
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would restrict posterior tipping, which would be the PEC minor and levator
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scapulae. So if I know these muscles can restrict this motion I may start
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attacking these with release techniques, lengthening techniques, pin and stretch
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techniques right. I have put stars by subscapularis, post delt and PEC minor. I
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know those of you who've been in the clinic for a while and done a lot of manual
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therapy, these three for manual release work like magic to improve shoulder
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flexion, so that might be a note you want to take. Joints alright so let's talk
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about the glenohumeral joint here we have posterior capsule, posterior cord of
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the coracle humeral ligament, and the inferior capsule which could all
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restrict flexion. So now what am I going to do, well we start thinking towards our
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mobilization techniques, things like our anterior to posterior glide, may be
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inferior glides, may be more general lateral distractions to work
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that posterior capsule, and don't forget AC and SC joints here, you really have to
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start thinking beyond just the shoulder if you're working in shoulder flexion,
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realizing that if we're looking at that hundred and eighty degrees of shoulder
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complex flexion, the scapula is also involved. Inferior SC joint mobilizations,
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posterior to anterior AC joint mobilizations work wonderfully. Fascia
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your clavi-pectoral, pectoral fascia and axillary fascia, all could use maybe a
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little instrument assisted soft tissue mobilization, all could definitely use a
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little attention from our myofascial bag of tricks to help relieve some of
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this restriction, and then of course if somebody got some nerves stuff, we would
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want to go ahead and do neurodynamic test. Unfortunately this is such a
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general stretch to the brachial plexus which goes down through our scalenes, and
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then underneath or clavicle, between our clavicle and our first rib and then
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underneath our pectoralis minor than just doing this, there's so many places to
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become restricted this would be a bad test for any one nerve, but maybe a sign
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that we need to go ahead and test further. Now a personal thought on this
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test, this is one of those goniometric assessments that i'll use if i have to
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because somebody else told me I had to, and what I mean is if somebody else is
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relying on flexion as a number to get back to playing sports, or a surgeon is
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looking for this number, or if somebody came in and this was the range of motion
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they felt most limited in, of course I'll use this test. What you guys will notice
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from this graph though is it's not starkly different from external rotation.
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So because I don't get all that much additional information from this test, if
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I've already done external rotation, which for me it's real easy to do
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internal rotation and external rotation and write those numbers down, for
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me i'll use external rotation instead of this test sense from a practical
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application standpoint, I tend to get the same information. So with all of the
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videos guys I hope this isn't intimidating, that it gives you a ton of
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ideas. I hope you will use this technique immediately if not on your colleagues
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then your friends, and then your colleagues, then of course you'll start
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using on patients because unless you practice it you're not going to remember
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it, you're not going to use it, and you won't take advantage of all of this
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potential information that comes with it. I look forward to hearing from you guys
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soon.
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