0:05 This is Brent of the Brookbush Institute at the independent training 0:09 spot in New York City, bringing you guys more goniometric assessment videos. In 0:12 this video we're going to do shoulder or glenohumeral internal rotation goniometry. 0:18 I'm going to have my friend Melissa come out, she's going to help me 0:20 demonstrate. Now in this range of motion we're looking for a firm end feel as I 0:26 hit those the end of those structures, and we're going to feel like that the 0:29 leather strap got pulled to full length, and then stopped us, and we're looking 0:34 for 60 to 70 degrees of internal rotation. Now I know if you guys look in 0:38 textbooks you'll see a much wider range, but I think you'll see them fairly 0:41 strict about how much scapular or shoulder girdle motion I allow, and I'm 0:47 going to use a little bit more conservative numbers because of how 0:50 strict I'm being. Now we got two lines we got to think about where am I going 0:56 to put my stability arm, where am I going to put my movement arm, my movement arm 1:01 is going to go from olecranon process to styloid process of the ulna, and you 1:06 guys can see I have a nice piece of orange Rock tape there, this is just like 1:10 the external rotation goniometry right, and then the stability arm is going to 1:15 go vertical or horizontal. So you can think either perpendicular to the table 1:21 or parallel on the table, and that's going to depend on what you're 1:25 comfortable with. I have a tendency to have a vertical stability arm on this 1:30 particular technique. Now to show you guys this technique, what you're going to 1:35 do is you're actually going to set up different than the external rotation 1:39 where i was i was here kind of facing my patient, this time I'm kind of over the 1:43 top of my patient. I'm going to go ahead and bring her arms 90 degrees, make sure that 1:49 the majority of her arm is stabilized by the table so I don't have to do a lot of 1:53 work here, she doesn't have to do a lot of work stabilizing her arm. I'm then 1:58 going to do this, I'm going to make sure her scapula is depressed, I think 2:02 as people lie down they have a tendency to do this, which of course 2:05 changes changes the range of motion quite a bit, and she looks super hypermobile 2:10 now, but if I do this and put her back into neutral make sure I keep the 2:15 scapula out of my range of motion, and then keep my hand here, that's going 2:21 to help keep us a nice good strict form. Now just like I did on external notation 2:25 I'm going to put my leg here so that I have my thigh as the fulcrum, that's also 2:29 going to keep her from going into abduction and help me to keep her from 2:34 going into anterior tipping here, which is going to add to our internal range of 2:37 motion. Make sure I'm in neutral pronation and supination, all right maybe 2:45 stabilize the front of the shoulder girdle as well, so I don't get any 2:48 protraction or anterior tipping, push her to end range, I get that nice firm stop. 2:55 I'm going to have Melissa hold this, make sure i watch it so I see that there's no 3:00 change. I'm going to get down an eye level, vertical stability arm, movement arm 3:09 from olecranon process, the styloid process, I got 56 degrees all right. So to 3:17 show you guys that one more time I'll kind of do a quick one run through. Pull 3:22 her arm up to 90 degrees of abduction, stabilize with this hand, so from on top 3:29 of the acromion process here, and then in front of the shoulder with the bottom of 3:33 my palm, my leg is here is her fulcrum, make sure I'm neutral here, go ahead and 3:39 pull her down to her end range, go ahead and hold that for me, set up my goniometer, 3:44 make sure my eyes are level with my measurement here, and I get 54 3:53 degrees. Alright thank you Melissa. Now our assessments fall into one of 3:59 these two broad categories of a clearing or diagnostic assessment, versus our 4:05 exercise selection assessments. I would definitely consider goniometery an 4:09 exercise selection assessment that's going to help me choose those 4:12 flexibility or mobility techniques, that the individual i'm working with needs to 4:17 move better. I'm going to go through all of those anatomical structures that are 4:22 that are key to human movement, being muscle, joint, fascia, nerve. So let's go 4:27 ahead and start with muscles. My posterior deltoid, infraspinatus and teres minor, my 4:33 external rotators of the shoulder, can all restrict internal range of motion. 4:38 Alright so I think you guys have probably seen that technique or try that 4:43 technique where you release your posterior deltoid, you know that this is 4:46 something that can get pretty trigger point laden if somebody had a 4:50 restriction in internal rotation, that's something I might want to give a shot. 4:54 The joint itself, my posterior and inferior capsule can restrict internal 5:00 range of motion. So all of those manual posterior glides or inferior glides, as 5:06 well as that self-administered shoulder mobilization video I created, that's 5:10 actually designed to affect these posterior and inferior capsule. So if we 5:16 we get past our muscular structures and we're still not at 60 to 70 degrees, we 5:22 might think about doing some of these joint mobilizations to help get some 5:26 range of motion back. We could look at the fascial system, right we've got this 5:30 posterior deltoid fascia that blends into the infraspinatus and teres minor and to 5:35 the posterior axilla. It's a fairly thick fascial sheath, so all those pin and 5:41 stretch techniques those fascial techniques, that instrument assisted soft 5:45 tissue mobilization techniques, that might be something you want to try to 5:49 use in this area if you think that that might be contributing to a restriction 5:54 here. And of course we can't forget the nerves, my friend Rob Flugel PT for the 6:01 maitland workshops would get on my case if we ever forgot the nerves. If if you 6:05 brought somebody into internal rotation and they got tingling or 6:09 they got some numbness, you know, you are lengthening the brachial plexus when you 6:15 push the scapula down into depression, you're lengthening the brachial plexus 6:19 when you pull somebody up into abduction, and pushing them back a little bit can 6:24 actually impinge that brachial plexus with either their clavicle or pectoralis 6:28 minor; and while that is not a problem for a healthy nerve, if somebody's 6:32 already little lit up, this might be the first test you do where you go Oh 6:37 tingling, maybe I should do my nerve tests. So a little smaller list than 6:43 external rotation goniometry, but I know it's still a fairly large list. Like 6:48 i said before guys, I don't want you to look at this list and go oh my goodness 6:51 so many structures to memorize, not the way to to take this stuff in. I want you 6:57 guys to look at this and think look at all of these opportunities, look at all 7:01 of these potential techniques I could use, all these structures I could affect 7:05 to potentially help my client or patient move better right. And of course if they 7:10 move better, chances are they're going to feel better. I look forward to hearing 7:13 about your outcomes guys, I hope it gave you a lot of new ideas. 7:23
