Week 10 Manual Therapies
Above link to video on topic of class discussion. We also uploaded home assessments to the class tutorial page.
What were your findings in the activity? Was it difficult for you to analyse scapulohumeral rhythm? Explain your answer
This week I did some online research and recorded the video for the set assessment (link at end of page). I found the tutorial videos helpful in helping see the comparison between good scapulohumeral rhythm and Scapular diskinesis. My participant had good results.
From my reading this week I’ve learned more about observation, anatomy, and assessment of function by movement and asking questions to the participant.
Definition: Scapulohumeral Rhythm
Physiopedia.com: ‘Scapulohumeral Rhythm, describes timing of movement at glenohumeral and scapulothoracic joint during shoulder elevation’.
This week I researched the above. I found out that there are 4 articulations required to elevate the arm. Physiopedia states: ‘The interplay of 4 articulations (Sternoclavicular Joint, Acromioclavicular Joint, Scapulothoracic Joint and Glenohumeral Joint) of the shoulder complex, results in a coordinated movement pattern of the arm elevation’.
To observe good scapulohumeral rhythm, each joint needs to work in coordination at various rates and phases of elevating the arm. A very good description of the movement, and what occurred in the demonstration video of arm movement is given as follows by phsiopedia.com:
‘When we perform flexion, the glenohumeral (GH) joint contributes 100°-120°. The scapula on the thorax contributes to elevation (flexion and abduction) of the humerus by upwardly rotating the glenoid fossa 50° to 60° from its resting position. If the humerus were fixed to the fossa, this alone would result in up to 60° of elevation of the humerus. The humerus, of course, is not fixed but can move independently on the glenoid fossa’.
In my assessment I observed even movement in early, middle, and end phases of movement on both sides of the body, however I did feel that the right side ‘clicked’ at one point more than the left. This may have been the positioning of my thumbs. From this week’s research I found out that in comparing scapulohumeral rhythm in children with adults, children’s scapulohumeral rhythm and scapular plane rotation is higher during lowering of the arm than adults, and shows greater upward rotation than adults respectively (physiopedia.com).
Scapulohumeral rhythm serves two purposes:
- Scapular rotation affects the length and tension of the glenohumeral muscles. The scapular needs to have a smooth upward rotation to shorten / lengthen muscles and sustain them through a range of movements.
- Good scapular rotation has a flow on effect to the function of the humerus, acromion, and glenoid fossa joints.
(physiopedia.com)
Potential Injuries
- Physiopedia.com: ‘Scapular dyskinesis occurs in 68 – 100% of patients with shoulder injuries (including glenohumeral instability, rotator cuff abnormalities, and labral tears’.
- Physiopedia.com: ‘An increased scapular component is generally thought to contribute to the scapulohumeral rhythm ratio in frozen or stiff shoulders’.
- Sports injuries
- Thoracic kyphosis or Clavicle fracture.
- Muscular causes (stiffness, injuries).
(Physiopedia.com)
Some Diagnostic Procedures
- Examination 2:1 ratio between glenohumeral elevation and scapulothoracic upward rotation
- Magnetic resonance imaging and x rays
- ‘The Simple Shoulder Test’ (12 questions (yes/no)
- DASH questionnaire (disability of arm, should, and hand)
- SPADI (shoulder pain and disability index
- Spinal and postural assessment
- Diagnosis can be obtained as to the origin of the problem before beginning myotherapy.
(Physiopedia.com)