THE HUMAN MOVEMENT

SYSTEM
Movement System Impairment
Syndromes of the Shoulder The Body System for which Physical
Therapists are Responsible.
The System of our Expertise
Shirley Sahrmann, PT, PhD, FAPTA
Professor Emeritus

Our Identity – APTA 2013

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Movement System Diagnoses

The Movement System
• Movement is an essential
function of life at all levels of
living organisms.
Musculoskeletal Neurological Cardiopulmonary
• From ions moving through
membranes to moving your limbs
to moving in your environment
MDT TBC

O’Sulli- Tissue
van Syn Impairments Neuromuscular Impairment
syndromes
The human movement system is a system MS Impairment
of physiological organ systems that interact (Neuromusculo-
to produce movement of the body and its skeletal) Syndromes
parts.
MSI Syndromes: the main emphasis is on making the diagnosis &
http://pt.wusm.wustl.edu/AboutUs/Pages/
and identifying the contributing factors
HumanMovementSystem.aspx

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Why Do Repeated Movements

Major Premises and Sustained Alignments
• Shoulder joint movement Change Movement Precision?
• Scapulothoracic and glenohumeral- should be consistent with optimal
kinesiology.
• Humerus should remain centered relative to the glenoid
• Alters intra & inter joint relative flexibility
• Activities of daily living, especially sport or fitness, • Muscle adaptations of relative length, strength, stiffness
• Cause alterations in muscle performance and thus induce movement • Neuromuscular activation and deactivation
impairments
• Muscle performance = strength, length, stiffness, and activation
patterns.
• Altered muscle performance
• Causes impairments of relative flexibility both intra and inter-joint.
• Personal characteristics affect the type and extent of the
adaptations in movement and muscle

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 Kinesiopathologic Model of Movement
System – A Theoretical Construct
Musculoskeletal
Repeated movements
INDUCERS
Sustained alignments
Relative Stiffness of
muscle & connective
tissue
Relative Flexibility
Intra-jt + Inter-jt
Motor Learning
Neural aff/efferent
Micro
Key Concepts II
• You get what you train
(many strategies to
create moments at a
joint or within a limb)
• Presence of a muscle
does not mean
appropriate use
• No magic in an exercise
except if the desired
motion is evident
Movement System Impairment Syndromes
Named for Movement Impairment Causing Pain
Scapular
• Internal rotation
• Anterior tilt
• Insufficient upward
rotation
• Abduction
• Depression
• Insufficient upward
rotation
• External rotation/adduction
• Insufficient upward
rotation
• Winging - pathological
• Elevation
Key Concepts l
Nervous Cardio-Pulmon - • Path of least resistance
endocrine for motion
• Relative Flexibility
Biomechanics • Intra-joint; intrinsic accessory
motion mobility
Personal Characteristics – intrinsic • Inter-joint; physiological
motion, e.g back vs hip
Activity Demands - extrinsic
• Relative Stiffness: passive
tension of muscle &
Tissue Adaptations connective tissue
Path of Least
• Joint (micro-instability)
Resistance hypermobility causes the
pain
Joint Accessory • Accessory motion
Hypermobility • Range & frequency
• What moves is what hurts
Macro trauma
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Movement System Impairment
(MSI) Syndromes
• Named for movement direction that causes symptoms
and that is impaired.
• Correction of the movement usually decreases the
symptoms.
• Identify the cause of the dysfunction & contributing
factors
• tissue & neuromuscular impairments
• Organize & cluster specific tissue and movement
impairments
• Provide a direction for treatment
• do not require identification of a specific
pathoanatomical structure (source)
Does strengthening the serratus
Improve scapular upward rotation? • Based on anatomy and kinesiology
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Cause versus Source
Operational Definitions
Humeral
Cause Source
• the tissue or
• Anterior glide
Superior glide • the mechanical
pathoanatomical
•
GH medial rotation factor (movement)
structure that is
•
• GH multidirectional accessory that results in
hypermobility tissue irritation symptomatic
• e.g. impingement,
• e.g. scapular
• GH hypomobility
insufficient upward supraspinatus
rotation, humeral tendin(itis, osis,
anterior glide opathy)
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 Pain Problem – No Identifiable Shoulder Flexion – Optimal or
Pathology Impaired?
• Movement
impairment
• Mechanisms
• Weakness
insufficient stiffness
• Length adaptation
• Activation
impairment
Interscapular pain for 2 years; radiological & electro-
physiological studies negative: No pathoanatomical diagnosis
MSI diagnosis: scapular internal rotation with anterior tilt &abduction
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The Exam Overview: Natural & Alignment – Indicates Muscle Performance

Corrected Impairments
• Standing • Prone • Scapular internal rotation –
• Alignment –scapula & • Isometric abduction • Posterior deltoid dominant, Serratus anterior, middle trap, rhomboids
insufficient
humerus • Shoulder rotation • Anterior tilt – pec minor stiff/short, serratus ant deficient
• Flexion – bilat & uni • Lateral • Insufficient upward rotation – rhomboids stiff/short, serratus
• Abduction • Medial insufficient, lower trap insufficient
• Shoulder lateral • Quadruped • Depression –
rotation • Rocking backward
• Upper trap long, serratus insufficient, latissimus stiff/short
Deltoid short
• Supine •

• Flexion • External Rotation/adduction

• Rhomboids, middle trap stiff/short, serratus ant long
• Diagonal abduction
• Winging – serratus anterior neuropathy
• Shoulder rotation
• Elevation –
• upper trap short, levator scap short, Lower trap long

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The Challenge: Keeping the Acute

Working Theory Problem From Becoming Chronic
• Musculoskeletal pain is
• A lifestyle issue like other health problems • Step 1: alleviate the acute symptoms
• Possible with a wide variety of interventions
• A progressive condition
• Step 2: prevent reoccurrence
• Starting with acute pain – first indication of
• Why is there reoccurrence?
tissue damage
• Because the cause – the impaired movement - has not
• High reoccurrence rate > chronic been identified & addressed. Tx is symptomatic not
• The result of tissue changes associated with preventive
degeneration of aging and tissue injury from • Step 3: identify the cause & contributing factors
impaired joint movement that develops with • Step 4: develop a treatment program that
activity includes
• Specific exercises
• Correction of performance of daily activities
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Movement System Impairment Thoracic Pain for 3 months after lifting
Syndromes – Guiding Theory file cabinet rated at 7/10

• Little things mean a lot!!!

• Underlying problem: micro-instability:
• The Wobble – Wobble condition
• Accessory motion (roll, spin, glide) becomes
excessive in one or more directions
(hypermobility/micro-instability)
• Micro-trauma from sheer force and points of
high contact pressure
• Becomes macro-trauma

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Alleviation of Symptoms Alleviate Strain–Support Scapula

Decrease Load on Shoulder

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Shoulder Flexion with Support of

No Sxs – Able to Lift 30#
Scapula

Initial 6 weeks later

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 Pre Post Muscle Strain

Treatment requires
alleviation of stress
time to heal
progressive strengthening

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Length-associated Changes Tested in Shortened Length

 Muscles maintained Lengthened

in lengthened
position
Long upper Control
trapezius
– add sarcomeres in
series
– shift length-tension
curve to right
– test weak at short
length

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2. 4 microns – sarcomere set-point

Normal - ideal

7 sarcomeres in series

Lengthened

11 sarcomeres in series Kendall: Muscles Testing & Function

Long muscle adds sarcomeres in series – alters length tension curve
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 Passive stiffness of muscle and connective tissue

RELATIVE STIFFNESS
Kendall: Muscles Testing & Function

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Relative Muscle Stiffness

Shoulder Flexion – with Correction • Hypertrophy of muscle increases the passive stiffness
Still had pain but was decreased No pain • Daily activities can induce different degrees of
hypertrophy of muscles on either side of a joint

12/23/2015 2/3/2016

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Muscle Stiffness = passive

tension
 Change in
tension/unit change
in length
– normal property
 Through the range
– sarcomeres in
parallel
– Muscle size

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 Thoracic Kyphosis
Sport? Effect on Shoulder

High correlation between passive stiffness & muscle size Initial 3 months later
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Scapular Internal Rotation: Short Scapulohumeral Muscles:

Shoulder Lateral Rotators stiffer than Serratus Anterior & Lower Trap less stiff
Serratus Anterior, Rhomboids & Trapezius than Glenohumeral Lateral Rotators

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Scapular Internal Rotation Scapular (Winging) Internal

What muscle lacks definition? Rotation

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Brace for Scapular Winging –
Shoulder Instability Capsular Shrinkage for Instability

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Definitions of Scapular
Correcting Movement Pattern
Movements
• Adduction (clavicular retraction-SC):
• the scapula translates medially along the rib
cage toward the vertebral column.
• Abduction: (clavicular protraction-SC)
• translates laterally

• During these motions there is associated

scapular internal or external rotation
occurring at the AC joint.

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Definitions of Scapular Movements

Definitions of Scapular Movements • Upward rotation (lateral rotation):
• AC joint
• Elevation:(clavicular elevation-SC) • a movement of the scapula about an
• a movement in which the scapula translates axis perpendicular to the plane of
along the ribcage in a cranial direction.
scapula
• inferior angle moves laterally
• glenoid fossa rotates to face cranially.
• Depression: (clavicular depression-SC) • SC joint
• translates in a caudal direction. • posterior axial rotation of clavicle also
contributes to UR.

• Downward rotation (medial rotation): Ludewig PM et al. 2009

• inferior angle moves medially
• glenoid fossa rotates to face caudally.

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 Definitions of Scapular Movements Definitions of Scapular Movements
• Anterior tilt/tipping: • Internal rotation:
• AC joint
• AC joint • rotation of the scapula about a
• a movement of the scapula about an vertical axis
axis parallel to the scapular spine • lateral border of the scapula moves
anteromedially
• coracoid moves anteriorly and caudally • vertebral border moves
posterolaterally such that
• inferior angle moves posteriorly and
• the costal surface of the scapula
cranially. faces more toward the midline of
• Posterior tilt/tipping: the body
• SC joint
• coracoid moves posteriorly and cranially • Clavicular protraction also results in
scapular IR
• inferior angle moves anteriorly and
caudally.
Ludewig PM et al. 2009
• External rotation:
• lateral border of the scapula moves Ludewig PM et al. 2009
posterolaterally
• vertebral border moves anteromedially

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Definition of Scapular Movements

Scapular Internal Rotators
• Winging:
• Posterior deltoid • AC Joint
• abnormal
• Teres major movement of the
scapula about a
• Teres minor vertical axis
• vertebral border
• Infraspinatus moves in a
posterior and
• Pectoralis Minor (Ludewig PM) lateral direction
away from the
ribcage (Hall,
CM, Brody LT.)

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Normal Resting Standing

Summary - Scapular Motions
Alignment
• Upward rotation:
• 19° SC joint clavicular retraction
• Primarily from the SC joint via posterior axial
rotation of the clavicle on the sternum • 6° SC clavicular elevation
• Secondarily from the AC joint
• Minimal from elevation at the SC joint • 41° scapular internal rotation
• 5° scapular upward rotation
• Posterior tilt:
• 13.5° scapular anterior tilt
• Primarily from the AC joint
• External rotation: 12 subjects; mean age 29.3
• SC joint (clavicular retraction)
Ludewig PM 2009
• AC joint
Ludewig PM 2009
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 Normal Movement at the AC and SC Normal Scapular Motion
Joints (Ludewig PM. JBJS; 2009) During Arm Elevation
Bone Pin study with 12 subjects
• During arm elevation 0-120° • Scapula externally rotates especially at
• SC joint: the end ranges. Ludewig PM 2009

• Retraction-16° • Scapula internally rotates until after

• Elevation-6° ~125° and then starts to externally
• Posterior axial rotation-31° rotate Braman JP 2009
• AC joint:
• By the end of arm elevation the scapula
• UR-11°
• IR-8°
ER so it is 10-20 degrees anterior to the
• Post tilt-19° frontal plane.

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Normal Scapular Motion During Clinical Assessment: Criteria for

Arm Elevation Normal Scapular Motion
• Scapula should elevate but only slightly (6- • By the end range of arm elevation:

10°) Ludewig PM 2009 • Acromion should be aligned with C6-7

• Root of spine of scapula should be aligned with T3
• The vertebral border of the scapula should reach 55-60
• Vertebral border of scapula should remain in (+ or - 5) .
contact with thorax • Normal scapular abduction is 7.5 cm (3”) from the
vertebral spine to the root of the spine of the scapula.
• Scapula should posteriorly tilt 10 Ludewig PM 2009
• Normal GH:ST rhythm: • Scapula should externally rotate so it is 10-20 anterior
• 2.1:1for abduction; 2.4:1 for flexion; 2.2:1 to the frontal plane Ludewig PM 2009

for scapular plane abduction Ludewig PM 2009

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Normal Scapular Motion During Normal Scapular Motion

Arm Lowering During Arm Lowering
• You shouldn’t see increased anterior Arm lowering
tilting during arm lowering • There should be decreased
• No prominence of vertebral border scapular relative to GH movement
• Scapula had greater posterior tilting (2°) during arm lowering compared to
during arm lowering compared to arm raising
Ludewig PM 2009 arm raising

Braman JP 2009

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Evidence for Scapular Movement Normal Resting Standing
Impairments - Impingement Alignment
• Decreased scapular posterior tilting
• Lukasiewicz AC et al, JOSPT 1999 • 19° SC joint clavicular retraction
• Ludewig PM & Cook TM, Phys Therapy 2000 • 6° SC clavicular elevation
• Hebert LJ et al, Arch Phys Med Rehabil,2002
• Endo K et al, J Orthop Sci 2001
• Lin JJ et al 2006 • 41° scapular internal rotation
• Decreased scapular upward rotation
• Ludewig PM & Cook TM, Phys Ther 2000
• 5° scapular upward rotation
• Endo K et al, J Orthop Sci 2001 • 13.5° scapular anterior tilt
• Lin et al 2006
• Lawrence RL 2014
• Increased scapular internal rotation 12 subjects; mean age 29.3
• Warner JP et al, Clin Orthop 1992 Ludewig PM 2009
• Ludewig PM & Cook TM, Phys Ther 2000

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Torque capabilities of Trapezius

The Examination (Fey AJ, …..Ludewig PM JOSPT Jan 2007 Abstract)

Standing • Used 3-D motion analysis and computer

• Alignment modeling of muscle moment arms
• Findings of Primary Torque Capability:
Abd-int rot – ant tilt Add – ext rot

• Scapula & Humerus

• Upper trap = clavicular elevation
• Shoulder Flexion
• Middle trap = scapular external rotation
• Lower trap = scapular external rotation
and upward rotation
• Serratus anterior = upward rotation,
posterior tilt and external rotation

Int rot ant tilt Dep –down rot - add

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MSI Scapular Syndromes

Internal rotation (AC joint)
• With anterior tilt (AC joint)
Scapular Internal Rotation
• With insufficient UR (SC & AC joint)
• With abduction (SC joint)

Depression (SC joint)

• With insufficient UR (SC & AC joint)

External rotation/adduction (SC & AC joint)

• With insufficient UR (SC & AC joint)

Winging (pathological) (AC joint)

Elevation (SC joint)

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 Scapular Internal Rotation with
Anterior Tilt at Rest and Insufficient
Anterior Tilt - End range
External Rotation - End range • Secondary test:
• Passively or actively increasing scapular external
rotation and posterior tilt at end range arm elevation
decreases symptoms.

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Scapular Internal Rotation with Scapular Internal Rotation with

Anterior Tilt - Muscle activation Anterior Tilt - Muscle activation
• Movement Impairments when there is a muscle
activation problem • Movement Impairments when there is a muscle
• These patients usually have a combination of IR and activation problem
tilting • These patients usually have a combination of IR and tilting

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Scapular Internal Rotation with

Anterior Tilt - Muscle activation

• Secondary test:
• correction by verbal and
manual cues to dissociate GH
Scapular IR with Ant.
from ST motion decreases Tilting:
symptoms return from Flexion
(strength  3/5 on MMT)
(muscle activation problem)

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 Alignment Structural Variations in Rib Cage
Impairments with Scapular Internal vs. External
Rotation
• Scapular Internal Structural considerations
Rotation: Heavy or long arms
Thoracic kyphosis
• Scapula > 30 to 40 Shape of rib cage/thorax
degrees anterior to
frontal plane at rest
• Scapular Anterior
Tilting or Tipping:
• Prominence of inferior
angle of scapula
• Criteria: >10-15
anterior tilt at rest =
abnormal Ludewig PM

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Scapular Internal Rotation with Scapular Internal Rotation with

Anterior Tilt - Muscle activation Anterior Tilt - Muscle activation
Intervention: Exercises cont.
• Serratus anterior activation and
strengthening
• Quadruped and standing shoulder flex
• Lower and middle trapezius activation
and strengthening:
• sidelying, standing, prone
• Pec. minor stretching
• Stretch SH muscles
Improve performance of serratus anterior
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Scapular Internal Rotation with Scapular Internal Rotation with

Anterior Tilt - Muscle activation Anterior Tilt - Muscle activation
Intervention: Quadruped Rocking Backward

Improve performance of serratus anterior

Elongation posterior scapulo-humeral GHJ extension contributes to scapular anterior tilt
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 Scapular Internal Rotation with Insufficient Scapular Upward
Insufficient Upward Rotation Rotation
Symptoms
• The movement • If pain is along vertebral border of scapula, the
impairment can source of the pain is usually the cervical spine.
happen anywhere • May have pain in the area of the rhomboid
muscle
in the ROM.
Activities
• Serratus anterior • New mothers
is the best • String instrument musicians
upward rotator • Weightlifters, heavy laborers, waitresses, jobs
that require arm to be sustained in flexion
• Sit with keyboard or arm rests too low

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Scapular Internal Rotation with tilt Scapular Internal Rotation with

and Insufficient Upward Rotation Insufficient Upward Rotation

• Right (involved) shoulder lower •Insufficient scapular

• Right acromion is low upward rotation during
• Scapula is downwardly rotated abduction
or depressed 8-15-06

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Scapular Internal Rotation with Abduction Scapular Internal Rotation with Abduction

• Alignment:
Backview:
• vertebral border >3”
(7.5 cm) from spine

Normal scapular
alignment
• 3” Sobush DB. 1996
• 2.5” Neumann DA,
2002
Excessive scapular abduction Corrected • 2” (5 cm) Kendall FP, Left scapula 4” (10 cm),
and internal rotation during 1993, Hoppenfeld S,
shoulder flexion 1976 right 3.5” (9 cm) from
spine
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Scapular Internal Rotation with Abduction Scapular Internal Rotation with
Abduction
• right scapular pain
and popping
• PhD student working
a lot at bench under
hood so has to reach
forward
• pain at end of day
• right handed
• large breasts

Activity contributing to abduction: wrestling

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Scapular Internal Rotation with

Scapular Internal Rotation with Abduction Abduction
• Avoid excessive
scapular abduction at
rest & during arm
motions

corrected

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Scapular IR with AT and ABD Scapular IR with AT and ABD

video

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Dissociating GH from ST Motion Scapular Depression
With Insufficient Upward Rotation
Movement Impairment -
Insufficient elevation
• Acromion depresses in the first
90 degrees of shoulder flexion or
abduction

• Acromion does not begin to

elevate after about 30 degrees of
arm elevation

• Acromion below C6 -7 at end

range
video

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Depression with Insufficient Scapular Depression

Scapular Upward Rotation Alignment
• Increased slope of
shoulders R > L
• Scapula lower than
T2 - T7 Swift TR, 1984
• Scapula normally
positioned between
T2-T7
Kendall FP 1993 and
Hoppenfeld S 1976

Unsuccessful Correction of Alignment Using Rhomboids

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Scapular Depression Scapular Depression With

With Insufficient Upward Rotation Insufficient Upward Rotation
Alignment
• Horizontal clavicles Swift
TR, 1984
• normally clavicle should have
slight upward slope
• 25-29° Todd TW,1912
• 20° Telford S, 1948
• 6° Ludewig PM 2009

• Right arm appears longer

• Increased slope Preferred Corrected

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 Scapular Depression Neck Pain with Scapular Depression and
With Insufficient Upward Rotation Cervical Flexion

videos

Pilates
Instructor

scapdrleft

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Scapular Depression External Rotation/Adduction

With Insufficient Upward Rotation With Insufficient Upward Rotation
Impairments of Resting Alignment
• Vertebral border of scapula is < 6.25 cm (2.5”)
from vertebral spine

• Scapula is oriented less than 30°anterior to

frontal plane

Arm rests need to be close to body and high enough to support • Clavicle is retracted more than 20-25°
shoulders at correct height.
• The thoracic spinal curve is often decreased or
Positioning keyboard on desktop may be better than keyboard flattened.
tray for arm support.
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External Rotation/Adduction External Rotation/Adduction

With Insufficient Upward Rotation With Insufficient Upward Rotation
• Scapula less visible
from sideview
compared to
person with
scapular IR

• Associated with flat

thoracic spine.

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External Rotation/Adduction Scapular Winging
With Insufficient Upward Rotation
Strength of serratus anterior on MMT is < 3/5
Primary Focus of Intervention
• Cue to relax thoracic spine and stop
constantly contracting scapular adductors.

• Improve performance of the serratus Scapular winging -

anterior long thoracic nerve
injury
• Increase extensibility of the rhomboids
and middle trapezius.

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Left Side Involved

Onset after biking trip for several weeks with

backpack on back; 20 y/o
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Shoulder Flexion – Note Rib Cage Shoulder Flexion

Video: initial (left) and 6 weeks later (right)

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Exercise 6 Weeks Later Scapular Elevation
Movement Impairment
• Excessive scapular elevation is usually
identified early in the range and
continues throughout arm elevation.

• The primary problem is typically limited

glenohumeral motion and not poor
muscle performance.

video
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Normal Humeral Movement: Rotation

Scapular Elevation
Primary Focus of Intervention: • During shoulder LR & MR with arm
• If GH hypomobility is present - increase GH abducted
mobility. • Movement should primarily be spinning; humeral head
• If rotator cuff function is deficient but expected should stay centered on the glenoid
to return focus is on restoring precise GH Neumann DA 2002

without scapular elevation.

• Humerus should spin on axis without horizontal
• If rotator cuff function is deficient and not
abduction
expected to improve then scapular elevation as
a compensatory technique may be necessary.

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Normal Humeral Alignment

Humeral Anterior Glide

• Activities/habits
• Racquet or throwing sports, volleyball, swimming
• Stand with hands clasped behind back
• Standing with arms crossed across chest

Kendall
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 Humeral Anterior Glide Humeral Anterior Glide: Abduction
Resting Alignment: humeral Humeral head more anterior
head relative to anterolateral relative to acromion during
corner of acromion active abduction

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Humeral Anterior Glide: Rotation Humeral Anterior Glide

Alignment Impairments
• forward shoulders
• greater than 1/3rd of
the humeral head
anterior of the
acromion
• proximal humeral head
anterior to the distal
end of the humerus
• indentation below
acromion posteriorly

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Humeral Anterior Glide

Shoulder Medial Rotation
Key Tests: Supine
• GHJ medial rotation (MR)– ROM limited and
impaired pattern of movement
• May have large arc of movement during humeral
MR (ant –inf)
• GHJ lateral rotation (LR)– ROM excessive and
impaired pattern of movement
• Anterior glide or large arc of motion (ant-sup)
• Horizontal adduction – ROM limited

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Humeral Anterior/Inferior Glide Humeral Anterior Glide
Involved Corrected
Key tests: Prone
• GHJ medial rotation
• weak in shortened range;
• ROM limited and associated with scapular IR
• GHJ lateral rotation
• palpate anterior glide
• horizontal abduction of GHJ
• associated with scapular IR and ’d prominence
of posterior deltoid
• Middle trapezius test
• Anterior glide
Normal

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Prone Shoulder Rotation Corrected

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Prone Middle Trapezius Test

Humeral Anterior/Inferior Glide
Monitoring Humeral Head

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 Humeral Anterior/Inferior Glide Humeral Anterior Glide

Treatment Overview
• Patient education and practice regarding
how to avoid excessive anterior glide
during daily activities

• Specific exercises to address contributing

factors

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Humeral Anterior Glide - Treatment

Humeral Anterior Glide
Emphasis on Exercises – emphasis on
precise motion, starting in
• Correct scapular motion during glenohumeral good alignment
motion: elevation, posterior tilt, upward • supine MR- lengthen
rotation or external rotation/adduction lateral rotators/posterior
McMahon PJ 1996 capsule while correcting
movement pattern
• Training for precise humeral rotation pattern
before strengthening
• prone MR- muscle
Falla A 2003 activation pattern then
progress to
• Lengthen lateral rotators & posterior capsule strengthening, esp
Harryman DT 1990; Ludewig PM 2002 2003; Bang MD 2000; subscapularis at endrange
Budoff JE 2005; McClure PW 2004, 2007; Tyler TF 2000;
Wilk KE 2002

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Humeral Anterior Glide: Prone Lateral Rotation Humeral Superior Glide

Movement Impairment
Moment arm
Insufficient inferior glide or relative superior glide
of posterior
deltoid is of the humeral head during arm elevation
reduced for
last half of
range
Ackland DC 2011

Decreases
volume of
Suggestion- Initiating shoulder LR with finger and wrist extension seems subacromial
to help facilitate correct recruitment of GH lateral rotators without space.
compensatory scapular motion.

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Humeral Superior Glide Humeral Superior Glide
Imprecise Movement

Neumann DA 2010
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Alignment Impairment
Finger is at lateral edge of acromion
Superior Glide During Passive Abduction

Scapular depression or Corrected scapular

DR- acromion drops over position allows better
humeral head alignment of humerus
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Passive Abduction on Opposite Shoulder Humeral Superior Glide

Key Tests:
• Humeral rotation in prone & supine
• May have mild loss of range, compression
into glenoid
• Long axis traction during rotation decreases
symptoms
• Manual inferior glide of humeral head
decreases symptoms
• Decreased humeral horizontal adduction
especially with arm in LR

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Glenohumeral Medial Rotation Syndrome Glenohumeral Medial Rotation Syndrome
Alignment
• Humeral MR
• Shoulders forward or
dropped
• If scapula is in IR and the
humeral alignment looks
normal, then the humerus
is really in LR
• If the scapula is in ER and
the humeral rotation looks
normal then the GH joint is
really in MR
Left painful; Lumbar extension Humeral MR True length of Kendall
Left > MR and humeral MR latissimus dorsi
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Glenohumeral Medial Rotation Syndrome

Glenohumeral Medial Rotation Syndrome

Scapulae abducted- Corrected scapulae-

Humerus appears MR
Preferred movement pattern is humeral MR
Humerus not MR
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Humeral Diagnoses

• Humeral Anterior Glide

• Humeral Superior Glide
• Glenohumeral Medial Rotation
• Glenohumeral Hypomobility
• Glenohumeral Multidirectional
Accessory Hypermobility

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