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.