The scapula backward tipping test: An inter-rater reliability study

Abstract

The purpose of this study was to determine the reliability of the scapula backward tipping test (SBTT) in detecting the presence of pectoralis minor (PM) tightness and subsequently scapula forward tipping, in a symptomatic population. PM tightness with scapula forward tipping has been described to cause pain and dysfunction in the shoulder region. 30 patients with a diagnosis of shoulder pain were randomly assigned and examined by 2 musculoskeletal physical therapists at a time. The procedure consisted of having the individual lay on the stomach in a neutral head position with palms in the anatomical position. The examiner firmly stabilized the inferior angle of the scapula with one hand and the fingers of the other hand hooked the under surface of the coracoid process. A gentle yet firm pull was imparted in an upward direction to sense tightness and to observe movement of the acromion up to the tragus of the ear. A comparison was made with the other side to sense restriction. Inter-rater reliability was determined using the kappa statistic. The SBTT was found to be reproducible between examiners (Kappa=0.735, SE of kappa=0.123, 95% confidence interval), with a percentage agreement of 86.67%. The SBTT may be incorporated as a simple yet effective test to determine the presence of PM tightness and subsequently scapula forward tipping.