You can only view 3 videos without an account. Become a Member to access all videos on the website.
Shoulder Internal Rotation Goniometry
Shoulder Internal Rotation Goniometry is a diagnostic procedure used to measure the range of motion (ROM) in the shoulder joint. It can be used to evaluate the health of the muscles, tendons, and joint ligaments around the shoulder, as well as identify any potential impairments or abnormalities in shoulder movement. The test is performed by having a clinician moves the patient's shoulder in an internal rotational motion and measure the angle of rotation. This information can be used for diagn
Transcript
00:00:0500:00:09
This is Brent of the Brookbush
00:00:0500:00:09
Institute at the independent training
00:00:0900:00:12
spot in New York City, bringing you guys more goniometric assessment videos. In
00:00:1200:00:18
this video we're going to do shoulder or glenohumeral internal rotation goniometry.
00:00:1800:00:20
I'm going to have my friend Melissa come out, she's going to help me
00:00:2000:00:26
demonstrate. Now in this range of motion we're looking for a firm end feel as I
00:00:2600:00:29
hit those the end of those structures, and we're going to feel like that the
00:00:2900:00:34
leather strap got pulled to full length, and then stopped us, and we're looking
00:00:3400:00:38
for 60 to 70 degrees of internal rotation. Now I know if you guys look in
00:00:3800:00:41
textbooks you'll see a much wider range, but I think you'll see them fairly
00:00:4100:00:47
strict about how much scapular or shoulder girdle motion I allow, and I'm
00:00:4700:00:50
going to use a little bit more conservative numbers because of how
00:00:5000:00:56
strict I'm being. Now we got two lines we got to think about where am I going
00:00:5600:01:01
to put my stability arm, where am I going to put my movement arm, my movement arm
00:01:0100:01:06
is going to go from olecranon process to styloid process of the ulna, and you
00:01:0600:01:10
guys can see I have a nice piece of orange Rock tape there, this is just like
00:01:1000:01:15
the external rotation goniometry right, and then the stability arm is going to
00:01:1500:01:21
go vertical or horizontal. So you can think either perpendicular to the table
00:01:2100:01:25
or parallel on the table, and that's going to depend on what you're
00:01:2500:01:30
comfortable with. I have a tendency to have a vertical stability arm on this
00:01:3000:01:35
particular technique. Now to show you guys this technique, what you're going to
00:01:3500:01:39
do is you're actually going to set up different than the external rotation
00:01:3900:01:43
where i was i was here kind of facing my patient, this time I'm kind of over the
00:01:4300:01:49
top of my patient. I'm going to go ahead and bring her arms 90 degrees, make sure that
00:01:4900:01:53
the majority of her arm is stabilized by the table so I don't have to do a lot of
00:01:5300:01:58
work here, she doesn't have to do a lot of work stabilizing her arm. I'm then
00:01:5800:02:02
going to do this, I'm going to make sure her scapula is depressed, I think
00:02:0200:02:05
as people lie down they have a tendency to do this, which of course
00:02:0500:02:10
changes changes the range of motion quite a bit, and she looks super hypermobile
00:02:1000:02:15
now, but if I do this and put her back into neutral make sure I keep the
00:02:1500:02:21
scapula out of my range of motion, and then keep my hand here, that's going
00:02:2100:02:25
to help keep us a nice good strict form. Now just like I did on external notation
00:02:2500:02:29
I'm going to put my leg here so that I have my thigh as the fulcrum, that's also
00:02:2900:02:34
going to keep her from going into abduction and help me to keep her from
00:02:3400:02:37
going into anterior tipping here, which is going to add to our internal range of
00:02:3700:02:45
motion. Make sure I'm in neutral pronation and supination, all right maybe
00:02:4500:02:48
stabilize the front of the shoulder girdle as well, so I don't get any
00:02:4800:02:55
protraction or anterior tipping, push her to end range, I get that nice firm stop.
00:02:5500:03:00
I'm going to have Melissa hold this, make sure i watch it so I see that there's no
00:03:0000:03:09
change. I'm going to get down an eye level, vertical stability arm, movement arm
00:03:0900:03:17
from olecranon process, the styloid process, I got 56 degrees all right. So to
00:03:1700:03:22
show you guys that one more time I'll kind of do a quick one run through. Pull
00:03:2200:03:29
her arm up to 90 degrees of abduction, stabilize with this hand, so from on top
00:03:2900:03:33
of the acromion process here, and then in front of the shoulder with the bottom of
00:03:3300:03:39
my palm, my leg is here is her fulcrum, make sure I'm neutral here, go ahead and
00:03:3900:03:44
pull her down to her end range, go ahead and hold that for me, set up my goniometer,
00:03:4400:03:53
make sure my eyes are level with my measurement here, and I get 54
00:03:5300:03:59
degrees. Alright thank you Melissa. Now our assessments fall into one of
00:03:5900:04:05
these two broad categories of a clearing or diagnostic assessment, versus our
00:04:0500:04:09
exercise selection assessments. I would definitely consider goniometery an
00:04:0900:04:12
exercise selection assessment that's going to help me choose those
00:04:1200:04:17
flexibility or mobility techniques, that the individual i'm working with needs to
00:04:1700:04:22
move better. I'm going to go through all of those anatomical structures that are
00:04:2200:04:27
that are key to human movement, being muscle, joint, fascia, nerve. So let's go
00:04:2700:04:33
ahead and start with muscles. My posterior deltoid, infraspinatus and teres minor, my
00:04:3300:04:38
external rotators of the shoulder, can all restrict internal range of motion.
00:04:3800:04:43
Alright so I think you guys have probably seen that technique or try that
00:04:4300:04:46
technique where you release your posterior deltoid, you know that this is
00:04:4600:04:50
something that can get pretty trigger point laden if somebody had a
00:04:5000:04:54
restriction in internal rotation, that's something I might want to give a shot.
00:04:5400:05:00
The joint itself, my posterior and inferior capsule can restrict internal
00:05:0000:05:06
range of motion. So all of those manual posterior glides or inferior glides, as
00:05:0600:05:10
well as that self-administered shoulder mobilization video I created, that's
00:05:1000:05:16
actually designed to affect these posterior and inferior capsule. So if we
00:05:1600:05:22
we get past our muscular structures and we're still not at 60 to 70 degrees, we
00:05:2200:05:26
might think about doing some of these joint mobilizations to help get some
00:05:2600:05:30
range of motion back. We could look at the fascial system, right we've got this
00:05:3000:05:35
posterior deltoid fascia that blends into the infraspinatus and teres minor and to
00:05:3500:05:41
the posterior axilla. It's a fairly thick fascial sheath, so all those pin and
00:05:4100:05:45
stretch techniques those fascial techniques, that instrument assisted soft
00:05:4500:05:49
tissue mobilization techniques, that might be something you want to try to
00:05:4900:05:54
use in this area if you think that that might be contributing to a restriction
00:05:5400:06:01
here. And of course we can't forget the nerves, my friend Rob Flugel PT for the
00:06:0100:06:05
maitland workshops would get on my case if we ever forgot the nerves. If if you
00:06:0500:06:09
brought somebody into internal rotation and they got tingling or
00:06:0900:06:15
they got some numbness, you know, you are lengthening the brachial plexus when you
00:06:1500:06:19
push the scapula down into depression, you're lengthening the brachial plexus
00:06:1900:06:24
when you pull somebody up into abduction, and pushing them back a little bit can
00:06:2400:06:28
actually impinge that brachial plexus with either their clavicle or pectoralis
00:06:2800:06:32
minor; and while that is not a problem for a healthy nerve, if somebody's
00:06:3200:06:37
already little lit up, this might be the first test you do where you go Oh
00:06:3700:06:43
tingling, maybe I should do my nerve tests. So a little smaller list than
00:06:4300:06:48
external rotation goniometry, but I know it's still a fairly large list. Like
00:06:4800:06:51
i said before guys, I don't want you to look at this list and go oh my goodness
00:06:5100:06:57
so many structures to memorize, not the way to to take this stuff in. I want you
00:06:5700:07:01
guys to look at this and think look at all of these opportunities, look at all
00:07:0100:07:05
of these potential techniques I could use, all these structures I could affect
00:07:0500:07:10
to potentially help my client or patient move better right. And of course if they
00:07:1000:07:13
move better, chances are they're going to feel better. I look forward to hearing
00:07:1300:07:17
about your outcomes guys, I hope it gave you a lot of new ideas.
Related Videos
Goniometry: Hip Internal Rotation at 90 Degree of Hip Flexion (90/90 Hip IR)
Ober's Test TFL Flexibility Assessment
Shoulder External Rotation Goniometry
Ely's Test (Rectus Femoris Flexibility Assessment)
Goniometry Hip External Rotation (in Prone)
Hip Flexion Goniometry
Hip Extension Goniometry
Goniometry Hip Internal Rotation (in prone)
Knee Extension with Hip Flexion Goniometry (Hamstring Length Test)
Goniometry: Hip External Rotation at 90 Degrees of Hip Flexion (90/90 Hip ER)
Femoral Nerve Neurodynamic Tests
Lumbar Movement Assessment
Slump Test
Upper Body Movement Assessment
Straight Leg Raise Test and Well Leg Raise Test