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

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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 videos. In
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this video we're going to do shoulder or glenohumeral internal rotation goniometry.
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I'm going to have my friend Melissa come out, she's going to help me
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demonstrate. Now in this range of motion we're looking for a firm end feel as I
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hit those the end of those structures, and we're going to feel like that the
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leather strap got pulled to full length, and then stopped us, and we're looking
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for 60 to 70 degrees of internal rotation. Now I know if you guys look in
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textbooks you'll see a much wider range, but I think you'll see them fairly
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strict about how much scapular or shoulder girdle motion I allow, and I'm
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going to use a little bit more conservative numbers because of how
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strict I'm being. Now we got two lines we got to think about where am I going
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to put my stability arm, where am I going to put my movement arm, my movement arm
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is going to go from olecranon process to styloid process of the ulna, and you
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guys can see I have a nice piece of orange Rock tape there, this is just like
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the external rotation goniometry right, and then the stability arm is going to
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go vertical or horizontal. So you can think either perpendicular to the table
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or parallel on the table, and that's going to depend on what you're
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comfortable with. I have a tendency to have a vertical stability arm on this
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particular technique. Now to show you guys this technique, what you're going to
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do is you're actually going to set up different than the external rotation
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where i was i was here kind of facing my patient, this time I'm kind of over the
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top of my patient. I'm going to go ahead and bring her arms 90 degrees, make sure that
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the majority of her arm is stabilized by the table so I don't have to do a lot of
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work here, she doesn't have to do a lot of work stabilizing her arm. I'm then
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going to do this, I'm going to make sure her scapula is depressed, I think
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as people lie down they have a tendency to do this, which of course
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changes changes the range of motion quite a bit, and she looks super hypermobile
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now, but if I do this and put her back into neutral make sure I keep the
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scapula out of my range of motion, and then keep my hand here, that's going
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to help keep us a nice good strict form. Now just like I did on external notation
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I'm going to put my leg here so that I have my thigh as the fulcrum, that's also
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going to keep her from going into abduction and help me to keep her from
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going into anterior tipping here, which is going to add to our internal range of
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motion. Make sure I'm in neutral pronation and supination, all right maybe
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stabilize the front of the shoulder girdle as well, so I don't get any
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protraction or anterior tipping, push her to end range, I get that nice firm stop.
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I'm going to have Melissa hold this, make sure i watch it so I see that there's no
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change. I'm going to get down an eye level, vertical stability arm, movement arm
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from olecranon process, the styloid process, I got 56 degrees all right. So to
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show you guys that one more time I'll kind of do a quick one run through. Pull
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her arm up to 90 degrees of abduction, stabilize with this hand, so from on top
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of the acromion process here, and then in front of the shoulder with the bottom of
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my palm, my leg is here is her fulcrum, make sure I'm neutral here, go ahead and
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pull her down to her end range, go ahead and hold that for me, set up my goniometer,
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make sure my eyes are level with my measurement here, and I get 54
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degrees. Alright thank you Melissa. Now our assessments fall into one of
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these two broad categories of a clearing or diagnostic assessment, versus our
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exercise selection assessments. I would definitely consider goniometery an
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exercise selection assessment that's going to help me choose those
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flexibility or mobility techniques, that the individual i'm working with needs to
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move better. I'm going to go through all of those anatomical structures that are
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that are key to human movement, being muscle, joint, fascia, nerve. So let's go
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ahead and start with muscles. My posterior deltoid, infraspinatus and teres minor, my
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external rotators of the shoulder, can all restrict internal range of motion.
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Alright so I think you guys have probably seen that technique or try that
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technique where you release your posterior deltoid, you know that this is
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something that can get pretty trigger point laden if somebody had a
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restriction in internal rotation, that's something I might want to give a shot.
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The joint itself, my posterior and inferior capsule can restrict internal
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range of motion. So all of those manual posterior glides or inferior glides, as
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well as that self-administered shoulder mobilization video I created, that's
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actually designed to affect these posterior and inferior capsule. So if we
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we get past our muscular structures and we're still not at 60 to 70 degrees, we
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might think about doing some of these joint mobilizations to help get some
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range of motion back. We could look at the fascial system, right we've got this
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posterior deltoid fascia that blends into the infraspinatus and teres minor and to
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the posterior axilla. It's a fairly thick fascial sheath, so all those pin and
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stretch techniques those fascial techniques, that instrument assisted soft
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tissue mobilization techniques, that might be something you want to try to
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use in this area if you think that that might be contributing to a restriction
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here. And of course we can't forget the nerves, my friend Rob Flugel PT for the
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maitland workshops would get on my case if we ever forgot the nerves. If if you
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brought somebody into internal rotation and they got tingling or
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they got some numbness, you know, you are lengthening the brachial plexus when you
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push the scapula down into depression, you're lengthening the brachial plexus
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when you pull somebody up into abduction, and pushing them back a little bit can
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actually impinge that brachial plexus with either their clavicle or pectoralis
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minor; and while that is not a problem for a healthy nerve, if somebody's
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already little lit up, this might be the first test you do where you go Oh
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tingling, maybe I should do my nerve tests. So a little smaller list than
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external rotation goniometry, but I know it's still a fairly large list. Like
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i said before guys, I don't want you to look at this list and go oh my goodness
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so many structures to memorize, not the way to to take this stuff in. I want you
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guys to look at this and think look at all of these opportunities, look at all
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of these potential techniques I could use, all these structures I could affect
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to potentially help my client or patient move better right. And of course if they
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move better, chances are they're going to feel better. I look forward to hearing
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about your outcomes guys, I hope it gave you a lot of new ideas.