Scapulohumeral Rhythm: Difference between revisions

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'''Shoulder movements'''
'''Shoulder movements'''
The interplay of 4 articulations ([[Sternoclavicular joint]], [[Acromioclavicular joint]], [[scapulothoracic joint]] and [[glenohumeral joint]]) of the shoulder complex, results in an coordinated movement pattern of the arm elevation. The involved movements at each joint are continuous, although occurring at various rates and at different phases of arm elevation.  
The interplay of 4 articulations ([[Sternoclavicular joint]], [[Acromioclavicular joint]], [[scapulothoracic joint]] and [[glenohumeral joint]]) of the shoulder complex, results in an coordinated movement pattern of the arm elevation. The involved movements at each joint are continuous, although occurring at various rates and at different phases of arm elevation.  
The movement of the scapula can be described by rotations in relation to the thorax. The scapula moves around a dorso-ventral axis, resulting in a rotation in the frontal plane. In this movement the glenoid cavity is turned cranially (upward rotation) or caudally (downward rotation). In the sagittal plane, around a latero-lateral axis the scapula rotates posteriorly (posterior tilting) or anteriorly (anterior tilting). External and internal rotation occurs around a cephalo-caudal (longitudinal) axis. The external rotation brings the glenoid cavity more into the frontal plane, whereas the internal rotation turns the glenoid cavity more to the sagittal plane. <ref name="58">Struyf, F., Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability, Scandinavian Journal of Medicine and Science in sports, jrg20, nr3, 2011, p352. Level of Evidence: 4.</ref>
The movement of the scapula can be described by rotations in relation to the thorax. The scapula moves around a dorso-ventral axis, resulting in a rotation in the frontal plane. In this movement the glenoid cavity is turned cranially (upward rotation) or caudally (downward rotation). In the sagittal plane, around a latero-lateral axis the scapula rotates posteriorly (posterior tilting) or anteriorly (anterior tilting). External and internal rotation occurs around a cephalo-caudal (longitudinal) axis. The external rotation brings the glenoid cavity more into the frontal plane, whereas the internal rotation turns the glenoid cavity more to the sagittal plane. <ref name="58">Struyf, F., Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability, Scandinavian Journal of Medicine and Science in sports, jrg20, nr3, 2011, p352. Level of Evidence: 4.</ref>
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'''Scapulohumeral Ratio'''
'''Scapulohumeral Ratio'''
The overall ratio of 2of GH to 1of ST motion during arm elevation is commonly used, and the combination of concomitant GH and ST motion most commonly referred to as scapulo-humeral rhythm. According to the 2-to-1 ratio frame-work, flexion or abduction of 90 in relation to the thorax would be accomplished through approximately 60of GH and 30of ST motion. Thus,&nbsp;<br>  
The overall ratio of 2of GH to 1of ST motion during arm elevation is commonly used, and the combination of concomitant GH and ST motion most commonly referred to as scapulo-humeral rhythm. According to the 2-to-1 ratio frame-work, flexion or abduction of 90 in relation to the thorax would be accomplished through approximately 60of GH and 30of ST motion. Thus,&nbsp;<br>  


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Search Strategy[edit | edit source]

We searched on the websites of Web of Science and Pubmed using the terms: "Scapular Humeral Rhythm", "Scapula Dyskinesia", "Scapula Position", "Scapula Stabilization", "Shoulder Movements", "Codman" and "Glenohumeral Motion".

Definition/Description[edit | edit source]

Scapulohumeral rhythm (also referred to as glenohumeral rhythm) is the kinematic interaction between the scapula and the humerus, first published by Codman in the 1930s. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

This interaction is important for the optimal function of the shoulder. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title When there is a change ment of the normal position of the scapula(describe) relative to the humerus, can this can cause a disfunction of the scapulohumeral rhythm. The change ment of the normal position is also called scapular dyskinesia. Various studies of the mechanism of the shoulder joint have attempted to describe the global motion capacity of the shoulder refer to that description, can you evaluate the shoulder to see if the function is correct? and explain the complex interactions between components involved in placing the hand in space.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Clinical Relevant Anatomy[edit | edit source]

Shoulder movements

The interplay of 4 articulations (Sternoclavicular joint, Acromioclavicular joint, scapulothoracic joint and glenohumeral joint) of the shoulder complex, results in an coordinated movement pattern of the arm elevation. The involved movements at each joint are continuous, although occurring at various rates and at different phases of arm elevation. The movement of the scapula can be described by rotations in relation to the thorax. The scapula moves around a dorso-ventral axis, resulting in a rotation in the frontal plane. In this movement the glenoid cavity is turned cranially (upward rotation) or caudally (downward rotation). In the sagittal plane, around a latero-lateral axis the scapula rotates posteriorly (posterior tilting) or anteriorly (anterior tilting). External and internal rotation occurs around a cephalo-caudal (longitudinal) axis. The external rotation brings the glenoid cavity more into the frontal plane, whereas the internal rotation turns the glenoid cavity more to the sagittal plane. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title


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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 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.

Inman et al. reported an inconsistent amount and type of scapular motion in relation to GH-motion during the initial 60°. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In this early phase (0-60°), motion occurs primarily at the GH joint, although stressing the arm may increase the scapular contribution. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title During abduction of the humerus in the plane of the scapula, an average of 43° of lateral rotation from the resting position has been reported, with peak lateral rotation generally occurring between 90° and 120° of humeral elevation. It must also be recognized, however, that elevation of the arm is often accompanied not only by elevation of the humerus but also by lateral rotation of the humerus in relation to the scapula. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

When we perform abduction, the GH-joint contributes 90-120°. The combination of scapular and humeral movement result in a maximum range of elevation of 150-180°. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Also by abduction Inman et al. reported an inconsistent amount and type of scapular motion in relation to GH-motion this time during the initial 30°. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In this early phase, motion occurs primarily at the GH joint, although stressing the arm may increase the scapular contribution. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Scapulohumeral Ratio

The overall ratio of 2of GH to 1of ST motion during arm elevation is commonly used, and the combination of concomitant GH and ST motion most commonly referred to as scapulo-humeral rhythm. According to the 2-to-1 ratio frame-work, flexion or abduction of 90 in relation to the thorax would be accomplished through approximately 60of GH and 30of ST motion. Thus, 

  • The GH joint contributes 100° to 120° of flexion and 90° to 120° of abduction.
  • The combination of scapular and humeral movement results in a maximum range of elevation of 150° to 180°.[1] [2]





  • During the initial 60of flexion or the initial 30° of abduction of the humerus, Inman and coworkers reported an inconsistent amount and type of scapular motion in relation to GH motion. [3]
  • The scapula has been described as seeking a position of stability in relation to the humerus during this period (setting phase). [4]
  • In this early phase, motion occurs primarily at the GH joint, although stressing the arm may increase the scapular contribution. [5]
  • It must also be recognized, however, that elevation of the arm is often accompanied not only by elevation of the humerus but also by lateral rotation of the humerus in relation to the scapula.
  • During abduction of the humerus in the plane of the scapula, an average of 43° of lateral rotation from the resting position has been reported, with peak lateral rotation generally occurring between 90° and 120° of humeral elevation. [6]

Clinical Relevance[edit | edit source]

Observation and examination of the scapulohumeal rhythm is commonly performed by physical therapists during postural and shoulder examinations. The notion of a proper "rhythm" is routinely used to describe the quality of movement at the shoulder complex.[7]

  • Alterations in scapular position and control afforded by the scapula stabilizing muscles are believed to disrupt stability and function of the glenohumeral joint Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title [8] [9], thereby contributing to shoulder impingement, rotator cuff pathology and shoulder instability.[10]
  • Given the role of the scapula in shoulder function, the ability to monitor the coordinated motion of the scapula and humerus, or scapulohumeral rhythm,[11] [12] may have clinical implications when dealing with overhead athletes and patients with shoulder pathologies.


Variations In Scapulohumeral Rhythm[edit | edit source]

  • Debate continues about the exact nature of this relationship in terms of static vs. dynamic pattern differences, the effects of various conditions such as external resistance, and the causal associations of "rhythm" dysfunction to specific shoulder pathologies
  • A number of studies have investigated this “rhythm,” with ratios reported varying between 1.25:1 and 2.69:1.
  • Ratios are often described as nonlinear, indicating changing ratios during dif-ferent portions of the ROM for elevation of the arm. The rhythm varies among individuals and may vary with external constraints.[13]


  • Some of the variability in ranges reported by investigators is due to individual structural variations (especially for the GH joint); another factor in variability may be the extent to which trunk contributions were isolated from humeral motions during the measurement.


References[edit | edit source]

  1. ↑ Rundquist P, Anderson DD, Guanche CA, et al. Shoulder kinematics in subjects with frozen shoulder. Arch Phys Med Rehabil 2003; 84:1473–1479.
  2. ↑ Barnes CJ, Van Steyn SJ, Fischer RA: The effects of age, sex, and shoulder dominance on range of motion of the shoulder. J Shoulder Elbow Surg 2001; 10:242–246.
  3. ↑ Inman B, Saunders J, Abbott L: Observations of function of the shoulder joint. J Bone Joint Surg Br 2004; 26:1.
  4. ↑ Dvir Z, Berme N: The shoulder complex in elevation of the arm: A mechanism approach. J Biomech 1978; 1:219
  5. ↑ Doody S, Waterland J: Shoulder movements during abduction in the scapular plane. Arch Phys Med Rehabil 1970; 51:595.
  6. ↑ Ludewig P, Cook T: Alterations in shoulder kine-matics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 2000; 80:276–291.
  7. ↑ McQuade KJ,Smidt GI. Dynamic Scapulohumeral Rhythm: The Effects of External Resistance During Elevation of the Arm in the Scapular Plane. J Orthop Sports Phys Ther 1998; 27(2): 125
  8. ↑ Itoi E. Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1992;1:131-139
  9. ↑ Weiser WM, Lee TQ, McMaster WC, McMahon PJ. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med 1999; 27: 801-805
  10. ↑ Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 2009;39: 90-104
  11. ↑ Codman E. Chapter II: Normal motions of the shoulder.Boston, MA 1934, 32-63
  12. ↑ Lockhart RD. Movements of the Normal Shoulder Joint and of a case with Trapezius Paralysis studied by Radiogram and Experiment in the Living. J Anat 1930; 64: 288-302
  13. ↑ McQuade K, Smidt G: Dynamic scapulohumeral rhythm: The effects of external resistance during elevation of the arm in the scapular plane. J Orthop Sports Phys Ther 1998; 27:125–133.



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