Scapulohumeral Rhythm: Difference between revisions

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==  Introduction  ==
==  Introduction  ==
<div>Optimal function of the shoulder is reliant on the coordinated movement of the scapula and the humerus. <ref name="1">Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998;26:325-337</ref>&nbsp;Various studies of the mechanism of the shoulder joint have attempted to describe the global motion capacity of the shoulder and explain the complex interactions between components involved in placing the hand in space.<ref>Cathcart CW: Movements of the shouLder girdle involved in those of the arm on the trunk. J Anat Physiol 1884; 18:209-218</ref>&nbsp;<ref>Cleland J: A lecture on the shoulder girdle and its  movements. Lancet 1881;1:11-12.</ref>&nbsp;Specifically, the kinematic interaction between the scapula and the humerus was introduced in the 1930s and termed "scapula-humeral rhythm” by Codman.<ref>Codman EA: The Shoulder,Boston: G.Miller &amp;amp;amp;amp;amp;amp; Company,1934</ref><br></div><div></div><div>
<div>Optimal function of the shoulder is reliant on the coordinated movement of the scapula and the humerus. <ref name="1">Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998;26:325-337</ref>&nbsp;Various studies of the mechanism of the shoulder joint have attempted to describe the global motion capacity of the shoulder and explain the complex interactions between components involved in placing the hand in space.<ref>Cathcart CW: Movements of the shouLder girdle involved in those of the arm on the trunk. J Anat Physiol 1884; 18:209-218</ref>&nbsp;<ref>Cleland J: A lecture on the shoulder girdle and its  movements. Lancet 1881;1:11-12.</ref>&nbsp;Specifically, the kinematic interaction between the scapula and the humerus was introduced in the 1930s and termed "scapula-humeral rhythm” by Codman.<ref>Codman EA: The Shoulder,Boston: G.Miller &amp;amp;amp;amp;amp;amp;amp; Company,1934</ref><br></div><div></div><div>
<br> Inman, Saunders and Abbott were the first to measure scapulohumeral rhythm using radiography and suggested what became the widely accepted 2:1 ratio between glenohumeral elevation and scapulothoracic upward rotation (SUR).<ref>Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996; 330: 3-12</ref> Since then imaging modalities (X-ray and magnetic resonance imaging)<ref>Poppen NK, Walker PS. Normal and abnormal motion of the shoulder. J Bone Joint Surg Am 1976;58: 195-201</ref>, cinematography <ref>Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J  Phys Med Rehabil 1988; 67: 238-245</ref>, goniometry <ref>Doody SG, Freedman L, Waterland JC. Shoulder movements during abduction in the scapular plane. Arch Phys Med Rehabil 1970; 51: 595-604</ref>&nbsp;<ref>Doody SG, Waterland JC, Freedman L. Scapulo-humeral goniometer. Arch Phys Med Rehabil 1970; 51:711-713</ref>&nbsp;<ref>Johnson MP, McClure PW, Karduna AR. New method to assess scapular upward rotation in subjects with shoulder pathology. J Orthop Sports Phys Ther 2001;31: 81-89</ref>, and more recently 3-dimensional tracking systems <ref>An KN, Browne AO, Korinek S, Tanaka S, Morrey BF. Three-dimensional kinematics of glenohumeral elevation. J Orthop Res 1991; 9: 143-149</ref>&nbsp;<ref>Johnson G, Stuart P, Mitchell S. A method for the measure-ment of three-dimensional scapular movement. Clin Biomech 1993; 8: 269-273</ref><ref>Meskers CG, Fraterman H, van der Helm FC, Vermeulen HM, Rozing PM. Calibration of the “Flock of Birds” elec-tromagnetic tracking device and its application in shoulder motion studies. J Biomech 1999; 32: 629-633</ref>have been used to gain a better appreciation of shoulder kinematics.  
<br> Inman, Saunders and Abbott were the first to measure scapulohumeral rhythm using radiography and suggested what became the widely accepted 2:1 ratio between glenohumeral elevation and scapulothoracic upward rotation (SUR).<ref>Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996; 330: 3-12</ref> Since then imaging modalities (X-ray and magnetic resonance imaging)<ref>Poppen NK, Walker PS. Normal and abnormal motion of the shoulder. J Bone Joint Surg Am 1976;58: 195-201</ref>, cinematography <ref>Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J  Phys Med Rehabil 1988; 67: 238-245</ref>, goniometry <ref>Doody SG, Freedman L, Waterland JC. Shoulder movements during abduction in the scapular plane. Arch Phys Med Rehabil 1970; 51: 595-604</ref>&nbsp;<ref>Doody SG, Waterland JC, Freedman L. Scapulo-humeral goniometer. Arch Phys Med Rehabil 1970; 51:711-713</ref>&nbsp;<ref>Johnson MP, McClure PW, Karduna AR. New method to assess scapular upward rotation in subjects with shoulder pathology. J Orthop Sports Phys Ther 2001;31: 81-89</ref>, and more recently 3-dimensional tracking systems <ref>An KN, Browne AO, Korinek S, Tanaka S, Morrey BF. Three-dimensional kinematics of glenohumeral elevation. J Orthop Res 1991; 9: 143-149</ref>&nbsp;<ref>Johnson G, Stuart P, Mitchell S. A method for the measure-ment of three-dimensional scapular movement. Clin Biomech 1993; 8: 269-273</ref><ref>Meskers CG, Fraterman H, van der Helm FC, Vermeulen HM, Rozing PM. Calibration of the “Flock of Birds” elec-tromagnetic tracking device and its application in shoulder motion studies. J Biomech 1999; 32: 629-633</ref>have been used to gain a better appreciation of shoulder kinematics.  


== Description  ==
== Description  ==


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.<ref>McClure P: Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo.J Shoulder Elbow Surg 2001;10:269–277.</ref>&nbsp;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.
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.<ref>McClure P: Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo.J Shoulder Elbow Surg 2001;10:269–277.</ref>&nbsp;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.  


*The GH joint contributes 100° to 120° of flexion and 90° to 120° of abduction.  
*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°.<ref>Rundquist P, Anderson DD, Guanche CA, et al. Shoulder kinematics in subjects with frozen shoulder. Arch Phys Med Rehabil 2003; 84:1473–1479.</ref>&nbsp;<ref>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.</ref>
*The combination of scapular and humeral movement results in a maximum range of elevation of 150° to 180°.<ref>Rundquist P, Anderson DD, Guanche CA, et al. Shoulder kinematics in subjects with frozen shoulder. Arch Phys Med Rehabil 2003; 84:1473–1479.</ref>&nbsp;<ref>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.</ref>


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== Clinical Relevance  ==


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.<ref>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</ref>


== Clinical Relevance ==
*Alterations in scapular position and control afforded by the scapula stabilizing muscles are believed to disrupt stability and function of the glenohumeral joint <ref name="1" />&nbsp;<ref>Itoi E. Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1992;1:131-139</ref>&nbsp;<ref>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</ref>, thereby contributing to shoulder impingement, rotator cuff pathology and shoulder instability.<ref>Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 2009;39: 90-104</ref>
*Given the role of the scapula in shoulder function, the ability to monitor the coordinated motion of the scapula and humerus, or scapulohumeral rhythm,<ref>Codman E. Chapter II: Normal motions of the shoulder.Boston, MA 1934, 32-63</ref>&nbsp;Lockhart RD. Movements of the Normal Shoulder Joint and of a case with Trapezius Paralysis studied by Radiogram and Experiment in the Living. J Anat1930; 64: 288-302 may have clinical implications when dealing with overhead athletes and patients with shoulder pathologies.


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.<ref>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</ref>
<br>


*Alterations in scapular position and control afforded by the scapula stabilizing muscles are believed to disrupt stability and function of the glenohumeral joint <ref name="1" />&nbsp;<ref>Itoi E. Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1992;1:131-139</ref>&nbsp;<ref>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</ref>, thereby contributing to shoulder impingement, rotator cuff pathology and shoulder instability.<ref>Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 2009;39: 90-104</ref>
*Given the role of the scapula in shoulder function, the ability to monitor the coordinated motion of the scapula and humerus, or scapulohumeral rhythm,<ref>Codman E. Chapter II: Normal motions of the shoulder.Boston, MA 1934, 32-63</ref>&nbsp;Lockhart RD. Movements of the Normal Shoulder Joint and of a case with Trapezius Paralysis studied by Radiogram and Experiment in the Living. J Anat1930; 64: 288-302 may have clinical implications when dealing with overhead athletes and patients with shoulder pathologies.


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== References ==
 
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Revision as of 20:01, 4 December 2013

 Introduction[edit | edit source]

Optimal function of the shoulder is reliant on the coordinated movement of the scapula and the humerus. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Various studies of the mechanism of the shoulder joint have attempted to describe the global motion capacity of the shoulder and explain the complex interactions between components involved in placing the hand in space.[1] [2] Specifically, the kinematic interaction between the scapula and the humerus was introduced in the 1930s and termed "scapula-humeral rhythm” by Codman.[3]


Inman, Saunders and Abbott were the first to measure scapulohumeral rhythm using radiography and suggested what became the widely accepted 2:1 ratio between glenohumeral elevation and scapulothoracic upward rotation (SUR).[4] Since then imaging modalities (X-ray and magnetic resonance imaging)[5], cinematography [6], goniometry [7] [8] [9], and more recently 3-dimensional tracking systems [10] [11][12]have been used to gain a better appreciation of shoulder kinematics.

Description[edit | edit source]

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.[13] 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.

  • 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°.[14] [15]



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.[16]

  • 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 [17] [18], thereby contributing to shoulder impingement, rotator cuff pathology and shoulder instability.[19]
  • Given the role of the scapula in shoulder function, the ability to monitor the coordinated motion of the scapula and humerus, or scapulohumeral rhythm,[20] Lockhart RD. Movements of the Normal Shoulder Joint and of a case with Trapezius Paralysis studied by Radiogram and Experiment in the Living. J Anat1930; 64: 288-302 may have clinical implications when dealing with overhead athletes and patients with shoulder pathologies.



References[edit | edit source]

  1. ↑ Cathcart CW: Movements of the shouLder girdle involved in those of the arm on the trunk. J Anat Physiol 1884; 18:209-218
  2. ↑ Cleland J: A lecture on the shoulder girdle and its movements. Lancet 1881;1:11-12.
  3. ↑ Codman EA: The Shoulder,Boston: G.Miller &amp;amp;amp;amp;amp;amp; Company,1934
  4. ↑ Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996; 330: 3-12
  5. ↑ Poppen NK, Walker PS. Normal and abnormal motion of the shoulder. J Bone Joint Surg Am 1976;58: 195-201
  6. ↑ Bagg SD, Forrest WJ. A biomechanical analysis of scapular rotation during arm abduction in the scapular plane. Am J Phys Med Rehabil 1988; 67: 238-245
  7. ↑ Doody SG, Freedman L, Waterland JC. Shoulder movements during abduction in the scapular plane. Arch Phys Med Rehabil 1970; 51: 595-604
  8. ↑ Doody SG, Waterland JC, Freedman L. Scapulo-humeral goniometer. Arch Phys Med Rehabil 1970; 51:711-713
  9. ↑ Johnson MP, McClure PW, Karduna AR. New method to assess scapular upward rotation in subjects with shoulder pathology. J Orthop Sports Phys Ther 2001;31: 81-89
  10. ↑ An KN, Browne AO, Korinek S, Tanaka S, Morrey BF. Three-dimensional kinematics of glenohumeral elevation. J Orthop Res 1991; 9: 143-149
  11. ↑ Johnson G, Stuart P, Mitchell S. A method for the measure-ment of three-dimensional scapular movement. Clin Biomech 1993; 8: 269-273
  12. ↑ Meskers CG, Fraterman H, van der Helm FC, Vermeulen HM, Rozing PM. Calibration of the “Flock of Birds” elec-tromagnetic tracking device and its application in shoulder motion studies. J Biomech 1999; 32: 629-633
  13. ↑ McClure P: Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo.J Shoulder Elbow Surg 2001;10:269–277.
  14. ↑ Rundquist P, Anderson DD, Guanche CA, et al. Shoulder kinematics in subjects with frozen shoulder. Arch Phys Med Rehabil 2003; 84:1473–1479.
  15. ↑ 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.
  16. ↑ 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
  17. ↑ Itoi E. Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1992;1:131-139
  18. ↑ 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
  19. ↑ Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 2009;39: 90-104
  20. ↑ Codman E. Chapter II: Normal motions of the shoulder.Boston, MA 1934, 32-63


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