Visual observation of scapulohumeral rhythm: Let’s take a look

Abstract

As physiotherapists we are taught to use our senses to help examine people for dysfunction found throughout the body. This includes vision, touch, sound, smell and hopefully not taste. Two of the most common traits we assess with observation are gait in patients with lower limb injury and scapulohumeral rhythm in patients with shoulder dysfunction. This clinical commentary aims to shed some light on evidence surrounding the use of visual observation for scapulohumeral rhythm for patients seeking treatment for shoulder dysfunction. Abnormal scapular movement is commonly referred to as scapular dyskinesis and has traditionally been linked to various types of shoulder dysfunction. Research indicates that between 64–100% of patients seeking treatment for shoulder instability and impingement respectively have abnormal scapular movements or dyskinesis [1]. Motions of the scapula, relative to the thorax, include upward/downward rotation about an anterior/posterior axis, internal and external rotation about a superior/inferior axis, and anterior/posterior tilt about a medial/lateral axis [2]. Generally, the scapula should progressively upwardly rotate and posteriorly tilt during humeral elevation [3]. Movement into internal or external rotation is more variable depending on plane and angle of humeral elevation [3]. Biomechanically, many studies have attempted to link abnormal scapular movements with specific shoulder dysfunctions, most commonly subacromial impingement syndrome. A recent systematic review looked at nine studies in an attempt to determine if patients with subacromial impingement syndrome exhibited alterations in scapular movements compared to unimpaired people [4]. When all studies were compiled, it was noted that patients with impingement demonstrated decreased upward rotation and decreased external rotation during humeral elevation compared to uninjured people [4]. Clinically, decreased upward rotation would present as decreased movement of the inferior angle superolaterally and decreased external rotation would appear as prominence of the medial scapular border (commonly referred to as winging). These alterations were most noticeable during elevation in the scapular plane [4]. These biomechanical studies allow a thorough understanding of changes found in patients but often lack translation to the clinical setting. There are several options, from a research perspective, available to guide clinicians on the appropriateness of any clinical measure, namely, reliability and diagnostic accuracy. Reliability coefficients provide insight into the agreement between multiple clinicians or agreement when one clinician performs the same task on multiple occasions. Reliability coefficients vary in calculation but generally output a value between 0 and 1 which is sometimes represented as 0–100. Measurements are recommended to have reliability coefficients greater than 0.90 or 90 to be considered sufficient for clinical