Lateral Scapular Test

 

From previous statics postural assessment, it can be observed that the client presents scapulae dyskinesis (scapula protracts and upward rotates, scapulae wing on the right side (Figure1) (Johnson, 2012). Dyskinesis is a prominence in any portion of the medial scapular border or inferior angle that is separated from the thorax due to excessive anterior tilting of the inferior angle (McClure et al., 2012) as a consequence of kyphotic sitting posture (Johnson, 2012).  The client scapula are 4 inches away from the spine, which means weakness in serratus anterior  and upper and lower trapezius. Scapular upward rotation suggest tension in the rhomboid major, serratus anterior lower trapezius (Jonhson, 2012) by a force couple between the upper and lower trapezius and the serratus anterior (McClure et al., 2012). As a result of this, it was decided to further test client’s scapulas by carrying out Lateral Scapular Slide Test (Hippensteel et al.,  2018).

Lateral Scapular Slide Test

The lateral scapular slide test (LSST) (Figure 20) examines the scapular muscle strength by measuring scapular symmetry in various positions (Shadmehr et al., 2010). This test will evaluate the position of the bilateral inferomedial scapular border position in relation to the nearest spinous process, with arm relaxed, hands placed akimbo, and arms elevated at 90° with glenohumeral internal rotation (Hippensteel et al.,  2018) (Figure, 2). A difference of =/> of 1.5cm is consider a positive finding (Tate et al., 2009). Additionally, Kibler (1991), reported that a difference higher of 1.5cm were associated with shoulder lessons, pain, decreased shoulder function. However, findings must be interpreted with caution as it was difficult to identify the inferior angle of the scapula. The client’ screening resulted  positive as there was a difference of >1.5 cm in two of the three positions (see in Table 1).  

Furthermore, as seen in figure 1, it can be observed that the client right shoulder drops. Burkhart et al., reported that is commonly observed scapular winging and shoulder drop on the affected area.

Exist contradictory finding in regards to the reliability and validity of LSST. Gibson et al., (1995) found aacceptable intra-rater reliablity (poor inter-rater reliability (ICC = 0.18-0.69), whirlst Park et al., (2017), reported a moderate to excellent inter-rater reliability (ICC 0.72- 0.84; ICC: 0.918- 0.968).

             Figure 1. Posterior static view of participant where scapular wing can be observed.

Figure 2. Posterior static view of participant where scapular wing can be observed.

A scapular kinematic alterations have been demonstrated in patients with subacromial impingement syndrome, due to  there is a correlation between increased scapular internal rotation, increased scapular posterior inclination, and decreased scapular upward rotation (Ludewig and Cook, 2000). It is believed that these scapular motion alterations reduce the subacromial space by failing to move the acromion away from the humeral head during arm elevation, resulting in increased compressive stresses on the rotator cuff tendons or long head of the biceps muscle (Borstad, 2006; Lucado 2011). 

Tightness of the short head of the biceps or the pectoralis minor through their attachment on the coracoid process can induce internal rotation and anterior tilting of the scapula, which can inhibit scapular upward rotation (Neumann, 2010; Sahrman, 2002). In contrast, the lower stabilisers of the scapula, including the serratus anterior, rhomboids, middle, and lower trapezius are inhibited (Lucado, 2011).

 

 Table 1. Results obtained in the LSST.

Position	Right	Left
Arms Relaxed	10 cm	11.5 cm
Hands in akimbo	9.5 cm	10.5 cm
Arms extended and Internal rotated	9.5 cm	11 cm

 

Table 2. Results obtained in the LSST.

Tight Muscles	Weak muscles
Pectoralis minor	Serratus Anterior
Short head of biceps	Lower trapezius
	Middle trapezius
	Rhomboids

 

 

 References:

Borstad, J. D. (2006) ‘Resting position variables at the shoulder: Evidence to support a posture-impairment association.’ Physical Therapy, 86(4)’ pp. 549–557.

Burkhart, S.S., Morgan, C.D. and Kibler, W.B., (2003). ‘The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation.’ Arthroscopy, 19(6), pp.641-661.

Gibson, M.H., Goebel, G.V., Jordan TM, et al.: A reliability study of measurement techniques to determine static scapular position. J Orthop Sports Phys Ther, 1995, 21: 100–106.

Hippensteel, K. J., Brophy, R., Smith, M. V., & Wright, R. W. (2018) ‘A Comprehensive Review of Physical Examination Tests of the Cervical Spine, Scapula, and Rotator Cuff.’ Journal of the American Academy of Orthopaedic Surgeons, 1.

Johnson, J. (2012) Postural assessment. Champaign, IL: Human Kinetics.

Lucado, A. M. (2011) ‘Scapular muscle imbalance: Implications for shoulder pain and pathology.’ Physical Therapy Reviews, 16(5) pp. 356–364.

Ludewig, P.M., and Cook, T.M. (2000) ‘Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.’ Physical Therapy, 80, pp. 276 –291.

McClure, P., Greenberg, E. and Kareha, S. (2012) ‘Evaluation and management of Scapular dysfunction.’ Sports Medicine and Arthroscopy Review, 20(1), pp. 39–48.
Neumann, D. (2010) Kinesiology of the musculoskeletal system: foundations for rehabilitation. 2nd ed. St Louis, MO: Mosby Elsevier.

Park, S.-Y. (2017) ‘Interrater reliability and intrarater reliability of lateral scapular slide tests of females in their 20s.’  Journal of Physical Therapy Science, 29(4), pp. 726–728.

Sahrmann, S.A. (2002) Does postural assessment contribute to patient care? Journal Orthopaedics  Sports Physical Therapy, 32, ppp.376 –379.

Tate, A.R., McClure, P., Kareha, S., Irwin, D., and Barbe, M.F. (2009) ‘A clinical method for identifying scapular dyskinesis, part 2: Validity.’ Journal  Athletic Training, 44, pp.165-173.