Reverse Scapulohumeral Rhythm This occurs in shoulders with reverse total shoulder arthroplasty (RTSA). RTSA is a surgical procedure used to address rotator cuff tears and various conditions which involve the dysfunction of the rotator cuff.
Why is the scapulohumeral rhythm important for the shoulder?
This coordinated interaction is important for the optimal function of the shoulder. When there is a change in the normal position of the scapula relative to the humerus, can this can cause a dysfunction of the scapulohumeral rhythm.
How do you calculate scapulohumeral rhythm?
The scapulohumeral rhythm is therefore defined as the ratio of the glenohumeral movement to the scapulothoracic movement during arm elevation. This is most often calculated by dividing the total amount of shoulder elevation (humerothoracic) by the scapular upward rotation (scapulothoracic).
Why does the scapulohumeral have an extensive range of motion?
One of the reasons for this extensive range is that shoulder abduction is much more complex than movement at the glenohumeral joint alone. Abduction requires coordinated movement of the glenohumeral joint and the scapulothoracic articulation and this is called the scapulohumeral (or scapulothoracic) rhythm.
Why does my Scapular position change after reverse total shoulder arthroplasty?
This occurs in shoulders with reverse total shoulder arthroplasty (RTSA). RTSA is a surgical procedure used to address rotator cuff tears and various conditions which involve the dysfunction of the rotator cuff. Typically, individuals who have undergone an RTSA will have changes in scapular position and show more upward rotation of the scapula.
What is reverse glenohumeral rhythm?
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. Scapulohumeral rhythm. This interaction is important for the optimal function of the shoulder.
What is the scapulohumeral rhythm?
Scapulohumeral rhythm: the coordinated motion of the scapula and humerus experienced during shoulder movement and motion that has been traditionally viewed as occurring at a ratio of 2:1 (2 degrees of humeral flexion/abduction to 1 degree of scapular upward rotation).
What is the function of scapulohumeral rhythm?
0:003:26Scapulohumeral Rhythm - YouTubeYouTubeStart of suggested clipEnd of suggested clipIn this video I'm going to talk about the scapular humor or rhythm of the shoulder. Time welcomeMoreIn this video I'm going to talk about the scapular humor or rhythm of the shoulder. Time welcome back to physio tutors. The scapular humeral rhythm refers to the coordinated movement of the humerus
What are the phases of scapulohumeral rhythm?
There are two key motion components of the scapulohumeral rhythm. The first is abduction of the glenohumeral joint. Abduction of the glenohumeral joint is produced primarily by the supraspinatus and deltoid muscles. The second part of the scapulothoracic rhythm is upward rotation of the scapula.
What causes abnormal scapulohumeral rhythm?
Abnormal scapulohumeral rhythm is a dysfunction that occurs within the scapulothoracic junction. There are many causes for this including: A rotator cuff tear where the individual does not have the musculotendinous connection and strength to abduct the arm.
What is scapulohumeral rhythm quizlet?
scapulohumeral rhythm. a regular pattern of scapular rotation that accompanies and facilitates humeral abduction. scapulothoracic joint (ST joint) articulation between the anterior scapula and the thoracic wall. Allows upward and downward rotation and Protraction and retraction of scapula.
What indicators best describe scapulohumeral rhythm?
What indicators BEST describe scapulohumeral rhythm? Beyond 30 degrees of glenohumeral and 60 degrees of flexion, for every 3 degrees of movement, 2 degrees of movement occurs at the glenohumeral joint and 1 degree at the scapulothoracic joint.
What are the 4 motions of the scapula?
The scapula is an important bone in the function of the shoulder joint. It engages in 6 types of motion, which allow for full-functional upper extremity movement including protraction, retraction, elevation, depression, upward rotation, and downward rotation.
What are the 3 fossa's of the scapula?
The scapula is described as having superior, medial, and lateral borders. Posteriorly, the scapula is divided into a supraspinous fossa and infraspinous fossa by the scapular spine. Anteriorly, on the costal surface, is the shallow subscapular fossa. Laterally is the glenoid fossa.
What is the most common cause of scapular Dyskinesis?
Playing sports increases your risk of the condition because more than 90% of unidirectional cases result from a dislocation injury. Sports with the highest likelihood of leading to scapular dyskinesis include: Gymnastics. Swimming.
How can I improve my scapulohumeral rhythm?
Strengthening of the posterior scapular stabilizers combined with stretching of the pectoral muscles may improve posture, increase shoulder & scapular strength, and may improve scapulohumeral rhythm.
What are the 3 processes of the scapula?
The scapula has three processes: the acromion, the spine, and the coracoid process. Muscle attachments to these landmarks are covered in the "Muscles" section. The ventral surface of the scapula abuts the thoracic rib cage and has a large concavity called the subscapular fossa where the subscapularis attaches.
What indicators best describe scapulohumeral rhythm?
What indicators BEST describe scapulohumeral rhythm? Beyond 30 degrees of glenohumeral and 60 degrees of flexion, for every 3 degrees of movement, 2 degrees of movement occurs at the glenohumeral joint and 1 degree at the scapulothoracic joint.
What are the 4 motions of the scapula?
The scapula is an important bone in the function of the shoulder joint. It engages in 6 types of motion, which allow for full-functional upper extremity movement including protraction, retraction, elevation, depression, upward rotation, and downward rotation.
What are the six major Scapulohumeral muscles?
What are the six scapulohumeral muscles?...deltoid.teres major.teres minor.infraspinatus.supraspinatus.subscapularis.
What are the 4 movements of the shoulder?
Adduction: downward movement of humerus medially toward the body from abduction, in the plane of the scapula. Flexion: the movement of humerus straight anteriorly. Extension: the movement of humerus straight posteriorly. External rotation: the movement of humerus laterally around its long axis away from the midline.
What is the scapulohumeral rhythm?
Scapulohumeral Rhythm is the synchronized movement between the scapula and the shoulders during shoulder elevation. There are two main joints involved in this relationship, the glenohumeral joint and the scapulothoracic joint. Together these joints are what create movement of the shoulder. This interaction is important for ...
Which joint affects scapulohumeral rhythm?
Scapulohumeral Rhythm is affected by the glenohumeral joint and the scapulothoracic joint. The glenohumeral joint is the articulation between the head of the humerus and the glenoid fossa of the scapula.
What is RTSA surgery?
RTSA is a surgical procedure used to address rotator cuff tears and various conditions which involve the dysfunction of the rotator cuff. Typically, individuals who have undergone an RTSA will have changes in scapular position and show more upward rotation of the scapula. Studies have found the motion of the scapula and the shoulder to be different in individuals who have RTSA than normal with scapulohumeral rhythm lower due to more scapulothoracic movement and less glenohumeral movement to elevate the arm.
What is the ratio of glenohumeral movement to scapulohumeral rhythm?
On average, the Scapulohumeral Rhythm has a 2:1 ratio; for every two degrees of glenohumeral movement, there is one degree of scapulothoracic movement in healthy adults.
What is it called when the glenohumeral joint is not functioning properly?
When the relationship between the glenohumeral joint and the scapulothoracic joint is not functioning properly, the dysfunction of the Scapulohumeral Rhythm can occur. This can result in pain, clicking, and instability in the shoulder. Your doctor can perform a physical assessment to determine if there are abnormalities in the shoulder. A change in the normal position of the scapula relative to the humerus is also called Scapular Dyskinesia.
What is the articulation between the anterior surface of the scapula and the posterior thoracic?
The scapulothoracic joint is the articulation between the anterior surface of the scapula and the posterior thoracic cage. When both of these joints are functioning properly, full shoulder elevation to 180 degrees is possible. Abnormal functioning or either joint can affect Scapulohumeral Rhythm and is indicative of muscular or joint dysfunction.
Which muscles connect the scapula to the humerus?
Scapulohumeral Rhythm Muscles. The muscles that connect the scapula to the humerus are called the scapulohumeral muscles. These are a large group of muscles that allow for shoulder adduction, abduction, external and internal rotation, flexion, and extension.
What is the purpose of the scapulohumeral rhythm?
First, it allows the glenoid fossa to maintain a good position for the various movements of the head of the humerus. Second, the changing position of the glenoid fossa allows for a better length-tension relationship in the muscles acting across the glenohumeral joint to produce shoulder motion.
What are the two motion components of the scapulohumeral rhythm?
There are two key motion components of the scapulohumeral rhythm. The first is abduction of the glenohumeral joint. Abduction of the glenohumeral joint is produced primarily by the supraspinatus and deltoid muscles. The second part of the scapulothoracic rhythm is upward rotation of the scapula. Upward rotation of the scapula is produced primarily ...
How many degrees of glenohumeral abduction are there?
If the scapulothoracic rhythm is properly coordinated, an individual will have approximately 120 degrees of glenohumeral abduction and 60 degrees of upward rotation of the scapula. There is about a 2:1 ratio of movement in the glenohumeral joint to that of the scapulothoracic articulation. These motions are not sequential, but mostly concurrent.
Why is shoulder abduction so complex?
One of the reasons for this extensive range is that shoulder abduction is much more complex than movement at the glenohumeral joint alone. Abduction requires coordinated movement of the glenohumeral joint and the scapulothoracic articulation and this is called the scapulohumeral (or scapulothoracic) rhythm.
What causes the scapula to not rotate?
For example, an injury to the long thoracic nerve that innervates the serratus anterior muscle, such as from heavy backpack straps, may impair function in the serratus anterior muscle. If the serratus anterior is not functioning properly, the scapula will not upward rotate enough.
Which part of the scapula is rotated?
The second part of the scapulothoracic rhythm is upward rotation of the scapula. Upward rotation of the scapula is produced primarily by the upper and lower fibers of the trapezius as well as the serratus anterior muscle.
Does the glenohumeral abduction occur at the same time?
That means that most of the glenohumeral abduction and the scapular upward rotation will be occurring at the same time. The figure below shows the humerus in 120 degrees of abduction. At this point part of the motion has occurred at the glenohumeral joint and part has occurred at the scapulothoracic articulation.
What is the difference between RTSA and normal shoulders?
RTSA shoulders show kinematics that are significantly different from normal shoulders. SHR in RTSA shoulders was significantly lower than in normal shoulders, indicating that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. With these observations, it m …
Where is the 3D of Orthopaedics and Rehabilitation?
3Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
Which part of the scapulothoracic rhythm is upward rotation?
The second part of the scapulothoracic rhythm is upward rotation of the scapula.
What is the glenohumeral rhythm?
Scapulohumeral rhythm (also called as glenohumeral rhythm) is the kinematic interaction between the scapula and the humerus, given by Codman in the year 1930. This coordinated interaction is important for the optimal function of the shoulder. When there is a change in the normal position of the scapula relative to the humerus, ...
What is the cause of rotator cuff impingement?
Studies have shown abnormal scapulohumeral rhythm as a major cause of rotator cuff impingement. Scapulohumeral rhythm is a common metric for assessing muscle function and shoulder joint motion.
What are the causes of shoulder impingement?
Alterations in scapular position and control afforded by the scapula stabilizing muscles are believed to disrupt stability and function of the glenohumeral joint, thereby contributing to shoulder impingement, rotator cuff pathology and shoulder instability
Why is my scapulohumeral rhythm abnormal?
The main reasons for an abnormal scapulohumeral rhythm are: 1. Fractures around the shoulder. 2. Glenohumeral joint degeneration. 3. Tightness of the shoulder muscles like pectoralis minor and biceps. 4. Reduced strength of the trapezius, serratus anterior and rotator cuff muscles.
What is the purpose of a physiotherapist for a scapulohumeral rhythm?
The physiotherapist, after a detailed assessment, will provide you with a rehabilitation program to correct the abnormal scapulohumeral rhythm.
What is the ratio of movement occurring at the glenohumeral joint to the scapulot?
Therefore the ratio of movement occurring at the glenohumeral joint to scapulothoracic joint is 2:1 and is known as the normal scapulohumeral rhythm.
What muscles are tight in the shoulder?
3. Tightness of the shoulder muscles like pectoralis minor and biceps
What is scapular kinematics?
Altered scapular kinematics are often associated with shoulder disorders. 17 Scapulohumeral rhythm (SHR) has been used to quantify the relative motion of the scapula and humerus, and it is a sensitive measure of shoulder dysfunction. 1, 5, 17, 20, 21 Many methods have been developed to measure shoulder motion and SHR, most of which are noninvasive and require placement of markers on the skin. 1 As with any methods using markers that are not rigidly fixed to the bones, there can be significant soft tissue movement that affects the measurement. 14 Fluoroscopic imaging and model-image registration techniques have been used for more than 20 years to quantify the motions of implants and bones in vivo, including the shoulder. 1, 9, 11 These radiographic methods quantify implant or bone motion directly and are unaffected by motions of the surrounding skin or soft tissues.
What is RTSA shoulder?
Reverse total shoulder arthroplasty (RTSA) has become a widespread treatment option for patients with rotator cuff arthropathy. RTSA studies have yielded promising results not only in the relief of chronic pain due to patients' previous osteoarthritis but in restoration of range of motion during functional activities. Despite good clinical outcomes, potential issues still occur after RTSA that are associated with deltoid tensioning and joint range of motion. Potential instability, scapular notching, and polyethylene wear may lead to significantly decreased functional outcomes and increased risk of RTSA failure. 2, 3, 4, 22 Better knowledge of shoulder joint motion is critical to understanding how shoulders with RTSA function. With a better understanding of reverse shoulder motion, optimal design and configuration of the implants can be achieved to increase functional outcomes and to lower RTSA failure rates. This study quantifies the kinematics of shoulders with RTSA and compares these results with kinematics of young healthy shoulders studied with identical methodology.
How long does it take to abduct a shoulder?
Motions were performed so that 1 cycle required approximately 15 seconds to complete, moving from the arm at the side to maximum abduction and returning to the arm at the side. Subjects were prompted to follow an investigator's example during elevation and lowering of the arm, with specific attention to keeping the torso upright in a standing posture. Subjects performed unweighted trials and weighted trials with a 1.4-kg hand-held weight. Subjects rested for 2 minutes between trials to minimize the potential for fatigue. Subjects were positioned so that the coronal plane was perpendicular to the x-ray beam.
Does RTSA measure shoulder motion?
Although studies have been performed to assess the maximum range of shoulder motion with RTSA, there is no information directly quantifying scapulothoracic and scapulohumeral motion in these shoulders. The goal of this study was to quantify SHR in shoulders with RTSA during abduction with and without a hand-held weight and to compare these measures with those previously obtained from healthy young shoulders by the same protocol and methods.
Is RTSA lower than normal?
RTSA shoulders show kinematics that are significantly different from normal shoulders. SHR in RTSA shoulders was significantly lower than in normal shoulders, indicating that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. With these observations, it may be possible to improve rehabilitation protocols, with particular attention to the periscapular muscles, and implant design or placement to optimize functional outcomes in shoulders with RTSA.
Is RTSA good for shoulder degeneration?
RTSA is an increasingly important treatment option for severe trauma and degeneration of the shoulder. There is active debate on the best implant geometric configurations to restore shoulder function but few quantitative in vivo data to guide this debate. We performed this study to determine if shoulders with RTSA show close to normal SHR and found that shoulders with RTSA exhibit low SHR values, or less glenohumeral motion, as the arm moves through the abduction arc.
Introduction
Clinical Relevant Anatomy
- Shoulder Movements
The interplay of 4 articulations (Sternoclavicular Joint, Acromioclavicular Joint, Scapulothoracic Joint and Glenohumeral Joint) of the shoulder complex, results in a coordinated movement pattern of the arm elevation. The involved movements at each joint are continuous, although oc… - Scapulohumeral Rhythm
It describes timing of movement at glenohumeral and scapulothoracic joint during shoulder elevation. First 30 degrees of shoulder elevation involves a "setting phase": 1. The movement is largely glenohumeral. 2. Scapulothoracic movement is small and inconsistent. And after the firs…
Epidemiology / Etiology
- It has been reported that scapular dyskinesis occurs in 68 - 100% of patients with shoulder injuries (including glenohumeral instability, rotator cuff abnormalities, and labral tears. Other studies showed that scapular upward rotation is significantly increased in patients with full-thickness rotator cuff tears compared with controls in both sagittal and scapular plane elevation. Also, an i…
Characteristics / Clinical Presentation
- Scapulohumeral rhythm is a common metric for assessing muscle function and shoulder joint motion. There is a three-dimensional scapular kinematic pattern during normal arm elevation that include upward rotation, posterior tilting and varying internal/external rotation dependent on the plane and angle of elevation. When there is change of the normal position of the scapula relate…
Differential Diagnosis
- There isn’t really a differential diagnosis for scapulohumeral rhythm disorders. But there are multiple causes for scapular dyskinesia and scapulohumeral rhythm disorders. Causative factors can be grouped into: 1. Bony causes include thoracic kyphosis or clavicula fracture. 1. Joint causes include high grade AC instability, AC arthrosis and instability, and GH joint internal deran…
Diagnostic Procedures
- 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 (ST) upward rotation (SUR). Since then imaging modalities (X-ray and magnetic resonance imaging), cinematography , goniometry , and more recently 3-dimensional tracking sy…
Outcome Measures
- The Simple Shoulder Test (SST) is an internationally used patient-reported outcome for clinical practice and research purposes. It was developed for measuring functional limitations of the affected shoulder in patients with shoulder dysfunction and contains 12 questions (yes/no). It is a reliable and valid instrument for evaluating functional limitations in patients with shoulder compl…
Examination
- Observation and examination of the scapulohumeral 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. Clinical measures (inclinometer, tape measure) are only capable of measuring scapular kinematics 2-dimensionall…
Physical Therapy Management
- It is essential to make a diagnosis about the cause of the scapulohumeral rhythm dysfunction before starting physical therapy. For example ‘Winged scapula’ of the scapula may be caused by a paresis of the muscle Serratus Anterior or by a dysfunction of the muscle Trapezius. Both passive and active movement disturbances can cause a scapulohumeral rhythm dysfunction. Causes m…