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Special Test

Scapular Asymmetry Test

Scapular Asymmetry Tests include the following:

  1. Lateral scapular slide test.
  2. Assessing the position of posterior acromion.
  3. Assessing the position of medial scapular border.
  4. Movement evaluation during abduction.
See Also: Scapular Winging test

Lateral scapular slide test

The lateral scapular slide test was originally developed by Kibler in 1991 as a method to detect asymmetric scapular resting positions with the arms in various degrees of abduction.

With patient standing, the examiner records measurement between inferior angle of scapula and spinous process of thoracic vertebra at same horizontal level in three positions (in the coronal plane):

  1. Position 1: With glenohumeral joint in neutral position (0 degree of abduction).
  2. Position 2: At 45 degrees of shoulder abduction and internal rotation.
  3. Position 3: With upper extremity in 90 degrees of abduction and full internal rotation.

A difference between sides of more than 1 cm is considered a positive Lateral scapular slide test (that means a scapular asymmetry).

A study on 46 subjects with shoulder dysfunction and 26 subjects without shoulder dysfunction, the results were as following:

  • The ICCs for intrarater reliability were .75, .77, and .80 and .52, .66, and .62, respectively, for subjects without and with shoulder impairments in 0, 45, and 90 degrees of abduction.
  • The ICCs for interrater reliability were .67, .43, and .74 and .79, .45, and .57, respectively, for subjects without and with shoulder impairments in 0,45 and 90 degrees of abduction. 

This study suggests that measurements of scapular positioning based on the difference in side-to-side scapular distance measures are not reliable. Furthermore, the results suggest that sensitivity and specificity of the Lateral scapular slide test measurements are poor and that the Lateral scapular slide test should not be used to identify people with and without shoulder dysfunction.

Kibler more recently proposed that this cut-off point be increased to 1.5 cm based on experiences within clinical practice combined with other unpublished work involving scapular malposition.

However, a study by Odom et al. found no improvement in sensitivity or specificity for the detection of scapular dyskinesis with any of the three testing positions or when the threshold for diagnosis was increased from 1.0 to 1.5 cm. Another study by Shadmehr et al. found that the test was unreliable. However, it should be noted that any study that evaluates the accuracy of a physical examination test for the detection of a specific pathology or defect, the findings on examination should always be coupled with the findings obtained from the diagnostic gold standard. In the case of scapular dyskinesis, there currently does not exist a diagnostic gold standard and, thus, inhibits study interpretation.

See Also: Scapular Dyskinesis
Lateral scapular slide test
Lateral scapular slide test

Position of posterior acromion

Measured from the posterior border of the acromion and the table surface with the patient supine.

The patient was positioned supine and instructed to relax. In this position, the assessor measured the distance between the posterior border of the acromion and the table bilaterally (measured vertically with a tape measure). Afterward, this procedure was repeated with the patient actively retracting both shoulders. To achieve active bilateral shoulder retraction, the patient was instructed to actively move both shoulders toward the table surface.

It has been suggested that the measurement of the distance between the posterior border of the acromion and the table is indicative of the length of the pectoralis minor muscle. A short or overactive pectoralis minor muscle can maintain the scapula in an excessive protracted or downwardly rotated position (ie, pseudowinging, a frequently observed type of abnormal scapular positioning).

Position of posterior acromion

Position of medial scapular border

This is measured from the medial scapular border to T4 spinous process.

The test was performed with the patient standing and instructed to stay relaxed. Both the fourth thoracic spinous process T4 and the medial scapular border were identified through palpation.

The distance between both anatomic landmarks was measured in the horizontal plane using a tape measure. Again, this procedure was repeated with the patient actively retracting both shoulders. To achieve active bilateral shoulder retraction, the patient was instructed to actively move both shoulders backward.

The normal distance from the medial scapular border to the thoracic spinous processes is believed to be 5.08 cm,” but this value “is not based on data or research findings.

Position of medial scapular border

Movement evaluation during abduction

The examiner classifies scapular movement during shoulder abduction into categories 1 to 4:

  1. Category 1: Inferior angle tilts dorsally compared with contralateral side.
  2. Category 2: Medial border tilts dorsally compared with contralateral side.
  3. Category 3: Shoulder shrug initiates movement.
  4. Category 4: Scapulae move symmetrically.

References

  1. Nijs J, Roussel N, Vermeulen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests. Arch Phys Med Rehabil. 2005 Jul;86(7):1349-55. doi: 10.1016/j.apmr.2005.03.021. PMID: 16003663.
  2. Odom CJ, Taylor AB, Hurd CE, Denegar CR. Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys Ther. 2001 Feb;81(2):799-809. doi: 10.1093/ptj/81.2.799. PMID: 11235656.
  3. Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg. 2002 Nov-Dec;11(6):550-6. doi: 10.1067/mse.2002.126766. PMID: 12469078.
  4. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.
Last Reviewed
June 6, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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