Scapular Assistance Test

Scapular Assistance Test SAT (or called Scapular Retraction Test SRT) is used to assess scapular motion and “scapular assistance” position during elevation and lowering of the arm to see if the impingement may be due to a lack of acromial elevation.

It’s used to exclude impingement in the subacromial space caused by entrapment or irritation, It’s a corrective maneuver designed to alter symptoms and identify the role of scapular dysfunction in the associated pathology.

Scapular Assistance Test was advocated by Kibler et al. in 2009.

How do you perform Scapular Assistance Test?

The patient is in a standing position and the examiner stands behind the patient.

The examiner places the fingers of one hand over the clavicle with the heel of the hand over the spine of the scapula to stabilize the clavicle and scapula and holds the scapula retracted. The other hand holds the inferior angle of the scapula.

As the patient actively abducts or forward flexes the arm, the examiner stabilizes and pushes the inferior medial border of the scapula up and medially while keeping the scapula retracted.

See Also: Scapular Winging Test

What does a positive Scapular Assistance Test mean?

The test is considered positive if there is reduction of pain in the “painful arc” and improved range of motion.

SAT Accuracy

A study by Michael Khazzam for Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff, he found that Scapular Assistance Test sensitivity and specificity for diagnosing of full-thickness rotator cuff tears was as following:

• Sensitivity: 81.7%
• Specificity: 80.8%

Another study found the kappa coefficient and percent agreement were 53% and 77%, respectively, when the test is performed in the scapular plane, and %62 and 91%, respectively, when the test is performed in the sagittal plane.

Modified Scapular Assistance Test

A modified Scapular Assistance Test, which included assisting posterior tipping of the scapula in addition to assisting upward rotation of the scapula, was found to possess acceptable interrater reliability for clinical use to assess the contribution of scapular motion to shoulder pain.

The clinician places one hand on the superior aspect of the involved scapula, with the fingers over the clavicle. The other hand is placed over the inferior angle of the scapular so that the heel of the hand is just over the inferior angle and the fingers are wrapped around the lateral aspect of the thorax.

The patient is asked to actively elevate his or her arm in the scapular plane, and during the movement the clinician facilitates upward rotation of the scapula by pushing upward and laterally on the inferior angle, as well as tilting the scapula posteriorly by pulling backwards on the superior aspect of the scapula

Notes

The Scapular Assistance Test (SAT) is presumed to indirectly measure the function of the scapula rotators; however, other factors, such as thoracic posture and pectoralis minor length, have also been hypothesized to affect scapular rotation, and it is possible that these could be affected by the manual pressure provided during the SAT.

More importantly, the SAT is used to directly assess the influence of scapular motion on shoulder pain.

Scapulothoracic Dyskinesis

Disturbances in the scapulothoracic motion sequence usually occur because of muscular imbalance in conjunction with pathology of the gleno-humeral and acromioclavicular joints. This can involve dysfunction from pain as a result of various shoulder disorders or from insufficient eccentric control function by the scapula-stabilizing muscles (trapezius, rhomboids, serratus anterior, and levator scapulae).
One can observe this scapular movement disturbance particularly when lowering the internally rotated arm s from an elevated position, because this movement places significant stress on the eccentric muscles (scapular provocation test).

Kibler differentiates three types of scapular dyskinesis:

1. Type I: Prominent inferior angle.
2. Type II: Prominent medial margin with posterior tilt.
3. Type III: Prominent superior angle.

See Also: Scapular Dyskinesis

References

1. Khazzam M, Gates ST, Tisano BK, Kukowski N. Diagnostic Accuracy of the Scapular Retraction Test in Assessing the Status of the Rotator Cuff. Orthop J Sports Med. 2018 Oct 4;6(10):2325967118799308. doi: 10.1177/2325967118799308. PMID: 30302349; PMCID: PMC6172943.
2. Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the Scapular Assistance Test. J Orthop Sports Phys Ther. 2006 Sep;36(9):653-60. doi: 10.2519/jospt.2006.2234. PMID: 17017270.
3. Clinical Tests for the Musculoskeletal System 3rd Edition.
4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.